Provider Demographics
NPI:1336621036
Name:CLEAR ACUPUNCTURE CORP
Entity Type:Organization
Organization Name:CLEAR ACUPUNCTURE CORP
Other - Org Name:CLEAR ACUPUNCTURE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PENDERGAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-848-7771
Mailing Address - Street 1:127 N DONALD AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6613
Mailing Address - Country:US
Mailing Address - Phone:312-848-7771
Mailing Address - Fax:
Practice Address - Street 1:1545 WAUKEGAN RD STE 2
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2166
Practice Address - Country:US
Practice Address - Phone:847-901-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001432171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty