Provider Demographics
NPI:1740960608
Name:PROCTOR, ELIZABETH (L AC, DIPL OM)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:L AC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 LILAC LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7341
Mailing Address - Country:US
Mailing Address - Phone:314-249-8701
Mailing Address - Fax:
Practice Address - Street 1:319 W STATE ST STE 210
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2156
Practice Address - Country:US
Practice Address - Phone:630-208-4678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000986171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist