Provider Demographics
NPI:1932500725
Name:SACRED TOUCH MASSAGE LLC.
Entity Type:Organization
Organization Name:SACRED TOUCH MASSAGE LLC.
Other - Org Name:SACRED TOUCH MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:PALOS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:630-656-3798
Mailing Address - Street 1:6101 KNOLL WOOD RD
Mailing Address - Street 2:306
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527
Mailing Address - Country:US
Mailing Address - Phone:630-656-3798
Mailing Address - Fax:
Practice Address - Street 1:50 BURR RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-0835
Practice Address - Country:US
Practice Address - Phone:630-656-3798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:0244674803
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.013300302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization