Provider Demographics
NPI:1679978373
Name:HEALING JUNCTION
Entity Type:Organization
Organization Name:HEALING JUNCTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOULTON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:773-880-9120
Mailing Address - Street 1:3322 N ASHLAND AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-0196
Mailing Address - Country:US
Mailing Address - Phone:773-880-9120
Mailing Address - Fax:773-880-9124
Practice Address - Street 1:3322 N ASHLAND #2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:773-880-9120
Practice Address - Fax:773-880-9124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198-000109171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty