Provider Demographics
NPI:1689941247
Name:PHOENIX HEALING, INC
Entity Type:Organization
Organization Name:PHOENIX HEALING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:IAQUINTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-301-9615
Mailing Address - Street 1:1920 SUNSET RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-1849
Mailing Address - Country:US
Mailing Address - Phone:843-301-9615
Mailing Address - Fax:
Practice Address - Street 1:1920 SUNSET RIDGE RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-1849
Practice Address - Country:US
Practice Address - Phone:843-301-9615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty