Provider Demographics
NPI:1467890962
Name:FLORES, ASHLEY (LAC ABT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:LAC ABT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 W PALMER BLVD
Mailing Address - Street 2:#3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2855
Mailing Address - Country:US
Mailing Address - Phone:312-404-5882
Mailing Address - Fax:
Practice Address - Street 1:2225 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5429
Practice Address - Country:US
Practice Address - Phone:312-404-5882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000954171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist