Provider Demographics
NPI:1154673762
Name:THRIVE INTEGRATIVE WELLNESS CENTER
Entity Type:Organization
Organization Name:THRIVE INTEGRATIVE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACNEIL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:630-313-2332
Mailing Address - Street 1:175 JACKSON AVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5321
Mailing Address - Country:US
Mailing Address - Phone:630-313-2332
Mailing Address - Fax:630-518-4883
Practice Address - Street 1:175 JACKSON AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5321
Practice Address - Country:US
Practice Address - Phone:630-313-2332
Practice Address - Fax:630-518-4883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000819171100000X
174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty