Provider Demographics
NPI:1417077389
Name:LINCOLN HEALTH & WELLNESS CENTER, LTD.
Entity Type:Organization
Organization Name:LINCOLN HEALTH & WELLNESS CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AKRIVOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-728-0800
Mailing Address - Street 1:5781 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4722
Mailing Address - Country:US
Mailing Address - Phone:773-728-0800
Mailing Address - Fax:773-728-0090
Practice Address - Street 1:5781 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4722
Practice Address - Country:US
Practice Address - Phone:773-728-0800
Practice Address - Fax:773-728-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU86673Medicare UPIN
IL928770Medicare ID - Type Unspecified