Provider Demographics
NPI:1366778730
Name:ACUBALANCE WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:ACUBALANCE WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOMAGALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:773-775-4257
Mailing Address - Street 1:6015 N NINA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2411
Mailing Address - Country:US
Mailing Address - Phone:773-775-4257
Mailing Address - Fax:773-775-4845
Practice Address - Street 1:6015 N NINA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-2411
Practice Address - Country:US
Practice Address - Phone:773-775-4257
Practice Address - Fax:773-775-4845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILNA173C00000X
IL198-000837171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty