Organization Name: | ENLIVEN WELLNESS CENTER LLC |
NPI Number: | 1003223157 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RUBY BOTELLO (PRESIDENT) |
Mailing Address: | 118 N Clinton St Suite 102 Chicago |
State: | IL US |
Postal Code: | 606612386 |
Phone Number: | 7737387146 |
Fax Number: | 3124884628 |
NPI Enumeration Date: | 07/21/2014 |
NPI Last Update Date: | 07/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 227009901 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |