Provider Demographics
NPI:1588643431
Name:SERENITY HEALTH & WELLNESS, LTD
Entity Type:Organization
Organization Name:SERENITY HEALTH & WELLNESS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:TOHTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-756-1778
Mailing Address - Street 1:600 W FULTON ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1259
Mailing Address - Country:US
Mailing Address - Phone:312-756-1778
Mailing Address - Fax:312-756-1777
Practice Address - Street 1:600 W FULTON ST
Practice Address - Street 2:SUITE 304
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1259
Practice Address - Country:US
Practice Address - Phone:312-756-1778
Practice Address - Fax:312-756-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009394111N00000X
IL038-010102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01627924OtherBLUE CROSS PROVIDER ID #