Provider Demographics
NPI:1598825556
Name:ALTERNATIVE HEALTH GROUP LLC
Entity Type:Organization
Organization Name:ALTERNATIVE HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:IN JAE
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM, L AC
Authorized Official - Phone:773-227-9150
Mailing Address - Street 1:2209 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6084
Mailing Address - Country:US
Mailing Address - Phone:773-227-9150
Mailing Address - Fax:773-227-9160
Practice Address - Street 1:2209 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647
Practice Address - Country:US
Practice Address - Phone:773-227-9150
Practice Address - Fax:773-227-9160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TP2701X
IL198.000610171100000X
IL070.016665225100000X
IL227.008514225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty