Provider Demographics
NPI:1225332703
Name:INTEGRATIVE WELLNESS CLINIC LTD.
Entity Type:Organization
Organization Name:INTEGRATIVE WELLNESS CLINIC LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TATIYANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:URBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:224-534-7167
Mailing Address - Street 1:9801 GROSS POINT RD
Mailing Address - Street 2:STE.203
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1173
Mailing Address - Country:US
Mailing Address - Phone:224-534-7167
Mailing Address - Fax:
Practice Address - Street 1:9631 GROSS POINT RD
Practice Address - Street 2:STE.107
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1264
Practice Address - Country:US
Practice Address - Phone:224-534-7167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.009006261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center