Organization Name: | INTENTIONAL HEALING CHIROPRACTIC & CENTER FOR WELL-BEING PA |
NPI Number: | 1023134731 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TAMARA ANN SUKUP (PRESIDENT) |
Mailing Address: | 949 Lake St Unit F3 Oak Park |
State: | IL US |
Postal Code: | 603011260 |
Phone Number: | 6122022866 |
Fax Number: | |
NPI Enumeration Date: | 03/22/2007 |
NPI Last Update Date: | 12/04/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 808 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |