Organization Name: | CUSTOM HEALING AND WELLNESS INC |
NPI Number: | 1447530852 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHANTE GRIGGS (CLINICAL PHARMACIST / NAPRAPATH) |
Mailing Address: | 5111 Sauk Trl Ste F Suite F Richton Park |
State: | IL US |
Postal Code: | 604711060 |
Phone Number: | 7089802348 |
Fax Number: | |
NPI Enumeration Date: | 08/17/2011 |
NPI Last Update Date: | 12/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM1300X |
License Number: | 051292165 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Multi-Specialty |
Taxonomy Definition: |