Provider Demographics
NPI:1437477742
Name:CLOUD GATE ACUPUNCTURE
Entity Type:Organization
Organization Name:CLOUD GATE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:L.AC
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:RUDIGIER
Authorized Official - Suffix:
Authorized Official - Credentials:LIC ACUPUNCTURIST
Authorized Official - Phone:773-617-2951
Mailing Address - Street 1:3723 N SOUTHPORT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3718
Mailing Address - Country:US
Mailing Address - Phone:773-617-2951
Mailing Address - Fax:
Practice Address - Street 1:3723 N SOUTHPORT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3718
Practice Address - Country:US
Practice Address - Phone:773-617-2951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0100X
IL198000736261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service