Provider Demographics
NPI:1346631439
Name:HOWE, LYDIA AMY
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:AMY
Last Name:HOWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5054 NORTH ST.LOUIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5529
Mailing Address - Country:US
Mailing Address - Phone:773-370-3174
Mailing Address - Fax:
Practice Address - Street 1:3259 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2129
Practice Address - Country:US
Practice Address - Phone:773-370-3174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227001168225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1750586749OtherTOTAL BALANCE CHIROPRACTIC