Provider Demographics
NPI:1366953101
Name:HEALTH ELEMENTS INTEGRATIVE MEDICAL INSTITUTE
Entity type:Organization
Organization Name:HEALTH ELEMENTS INTEGRATIVE MEDICAL INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM, PHD, LAC
Authorized Official - Phone:708-914-4650
Mailing Address - Street 1:19740 GOVERNORS HWY STE 117
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2085
Mailing Address - Country:US
Mailing Address - Phone:708-914-4650
Mailing Address - Fax:
Practice Address - Street 1:19740 GOVERNORS HWY STE 117
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2085
Practice Address - Country:US
Practice Address - Phone:708-914-4650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearchGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain