Provider Demographics
NPI:1710120647
Name:REFLECTIONS OF HEALTH INTEGRATIVE CARE CENTER, LLC
Entity Type:Organization
Organization Name:REFLECTIONS OF HEALTH INTEGRATIVE CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO/ADMINISTRATIVE DIR.
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:LCMT, CPFT
Authorized Official - Phone:773-826-9455
Mailing Address - Street 1:2950 W WASHINGTON BLVD
Mailing Address - Street 2:MARTIN LUTHER KING JR. BOYS & GIRLS CLUB BLDG
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1934
Mailing Address - Country:US
Mailing Address - Phone:773-826-9455
Mailing Address - Fax:866-403-6309
Practice Address - Street 1:2950 W WASHINGTON BLVD
Practice Address - Street 2:MARTIN LUTHER KING JR. BOYS & GIRLS CLUB BLDG
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1934
Practice Address - Country:US
Practice Address - Phone:773-826-9455
Practice Address - Fax:866-403-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty