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Contact Information

FIVE PHASE WELLNESS CENTER, LLC
708 MAIN ST
EVANSTON, IL60202-1702
 Phone: 847-905-0440
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Acupuncturist

171100000X
Indicates primary specialty

NPI Profile & details for FIVE PHASE WELLNESS CENTER, LLC

NPI # 1265726178
LBN Legal business name FIVE PHASE WELLNESS CENTER, LLC
Authorized official RYAN LOMBARDO - (WELLNESS DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 06/08/2011
Last updated 06/08/2011 - About 15 years ago
Identifiers
IL License # 198000495
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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