Provider Demographics
NPI:1255193876
Name:BRIGHT SHEN ACUPUNCTURE
Entity type:Organization
Organization Name:BRIGHT SHEN ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KINGA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN BRUNT
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:847-648-7990
Mailing Address - Street 1:1808 MARYLAND DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-2734
Mailing Address - Country:US
Mailing Address - Phone:847-648-7990
Mailing Address - Fax:
Practice Address - Street 1:142 S GARY AVE STE 111
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2226
Practice Address - Country:US
Practice Address - Phone:847-648-7990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL15661281OtherCAQH
IL19800014OtherIDFPR