Provider Demographics
NPI:1184281594
Name:BELT, GENEVIEVE (LAC)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:BELT
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 1:577 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-3357
Mailing Address - Country:US
Mailing Address - Phone:815-474-1528
Mailing Address - Fax:
Practice Address - Street 1:113 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1912
Practice Address - Country:US
Practice Address - Phone:630-762-9864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001465171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist