Provider Demographics
NPI:1649741117
Name:CENTERED HOLISTIC, LLC
Entity Type:Organization
Organization Name:CENTERED HOLISTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:RAYNER
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:312-819-4239
Mailing Address - Street 1:111 N WABASH AVE STE 1414
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3070
Mailing Address - Country:US
Mailing Address - Phone:312-819-4239
Mailing Address - Fax:
Practice Address - Street 1:111 N WABASH AVE STE 1414
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3070
Practice Address - Country:US
Practice Address - Phone:312-819-4239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty