Provider Demographics
NPI:1023431426
Name:ADVANCED NATURAL HEALTH LTD
Entity type:Organization
Organization Name:ADVANCED NATURAL HEALTH LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SITIHIAMPHONE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHETCHAMPHONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-495-1855
Mailing Address - Street 1:17W580 BUTTERFIELD ROADD
Mailing Address - Street 2:SUITE J
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181
Mailing Address - Country:US
Mailing Address - Phone:630-495-1855
Mailing Address - Fax:630-495-1856
Practice Address - Street 1:17W 580 BUTTERFIELD ROADD
Practice Address - Street 2:SUITE J
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181
Practice Address - Country:US
Practice Address - Phone:630-495-1855
Practice Address - Fax:630-495-1856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000604171100000X
IL038009954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232336OtherBCBS
IL100151188OtherPTAN
IL207582Medicare PIN