Provider Demographics
NPI:1881029411
Name:PYNE, ANNA (LAC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:PYNE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N KINGSBURY ST
Mailing Address - Street 2:RIVERWALK 6-A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-7432
Mailing Address - Country:US
Mailing Address - Phone:312-321-0004
Mailing Address - Fax:312-321-1740
Practice Address - Street 1:900 N KINGSBURY ST
Practice Address - Street 2:RIVERWALK 6-A
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:312-321-1740
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198-000383171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist