Provider Demographics
NPI:1497130215
Name:PURE ACUPUNCTURE
Entity Type:Organization
Organization Name:PURE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMADEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-523-4675
Mailing Address - Street 1:110 S JOHNSON ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-3259
Mailing Address - Country:US
Mailing Address - Phone:312-523-4675
Mailing Address - Fax:
Practice Address - Street 1:110 S JOHNSON ST
Practice Address - Street 2:SUITE 207
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-3259
Practice Address - Country:US
Practice Address - Phone:312-523-4675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000857171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty