| Organization Name: | WELLNESS INTEGRATIVE MEDICINE, INC |
| NPI Number: | 1114357811 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RUSHIA BUTLER (OWNER) |
| Mailing Address: | 3330 W 177th St Ste 2g Hazel Crest |
| State: | IL US |
| Postal Code: | 604292184 |
| Phone Number: | 8472354674 |
| Fax Number: | 8472354674 |
| NPI Enumeration Date: | 11/15/2013 |
| NPI Last Update Date: | 12/03/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 036103914 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |