Provider Demographics
NPI:1225416613
Name:BIODYNAMIC HEALTH SYSTEMS
Entity Type:Organization
Organization Name:BIODYNAMIC HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE, CRANIOSACRAL, HERBS
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, BCST
Authorized Official - Phone:773-789-7143
Mailing Address - Street 1:4605 N CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2014
Mailing Address - Country:US
Mailing Address - Phone:773-789-7143
Mailing Address - Fax:
Practice Address - Street 1:4633 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2181
Practice Address - Country:US
Practice Address - Phone:773-789-7143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001246171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty