Provider Demographics
NPI:1982850145
Name:STELLAR BODYTHERAPY, LTD.
Entity Type:Organization
Organization Name:STELLAR BODYTHERAPY, LTD.
Other - Org Name:THE BODHI TREE CENTER FOR THE HEALING ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:HILDRETH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:630-306-9074
Mailing Address - Street 1:1110 MEDINAH ST
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-1724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 DEWES ST
Practice Address - Street 2:STE. D
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-4374
Practice Address - Country:US
Practice Address - Phone:630-235-9075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010096111N00000X
IL227003862225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty