Provider Demographics
NPI:1659709772
Name:PULLING DOWN THE MOON
Entity Type:Organization
Organization Name:PULLING DOWN THE MOON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-997-2135
Mailing Address - Street 1:2127 W DICKENS AVE
Mailing Address - Street 2:COACH HOUSE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4520
Mailing Address - Country:US
Mailing Address - Phone:847-997-2135
Mailing Address - Fax:
Practice Address - Street 1:900 N KINGSBURY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-7432
Practice Address - Country:US
Practice Address - Phone:312-321-0004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227013072225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty