Provider Demographics
NPI:1649748674
Name:CENTER FOR INTEGRATIVE AND FUNCTIONAL HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:CENTER FOR INTEGRATIVE AND FUNCTIONAL HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JURATE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-980-1400
Mailing Address - Street 1:1 TIFFANY PT STE 105
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2915
Mailing Address - Country:US
Mailing Address - Phone:630-980-1400
Mailing Address - Fax:630-980-1441
Practice Address - Street 1:1 TIFFANY PT STE 105
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2915
Practice Address - Country:US
Practice Address - Phone:630-980-1400
Practice Address - Fax:630-980-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty