Provider Demographics
NPI:1669031936
Name:POMEROY, JUSTIN (ACT (ACUPUNTURE THER)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:POMEROY
Suffix:
Gender:M
Credentials:ACT (ACUPUNTURE THER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 W. SCHUBERT AVE.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614
Mailing Address - Country:US
Mailing Address - Phone:773-281-4450
Mailing Address - Fax:
Practice Address - Street 1:1350 W. SCHUBERT AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:773-281-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000252171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist