1760761621 NPI number — NATALIA KLEINAITIS L.AC, DIPL. O.M

Table of content: NATALIA KLEINAITIS L.AC, DIPL. O.M (NPI 1760761621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760761621 NPI number — NATALIA KLEINAITIS L.AC, DIPL. O.M

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEINAITIS
Provider First Name:
NATALIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.AC, DIPL. O.M
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760761621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7240 FRANKLIN ST
Provider Second Line Business Mailing Address:
UNIT 3B
Provider Business Mailing Address City Name:
FOREST PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60130-1178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-731-1103
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 LAKE ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60301-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-848-8488
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  198.000824 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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