Provider Demographics
NPI:1144981473
Name:SHAPERZ INC
Entity type:Organization
Organization Name:SHAPERZ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. VICTOR-LUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:773-875-0069
Mailing Address - Street 1:9712 S KEELER AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3407
Mailing Address - Country:US
Mailing Address - Phone:773-875-0069
Mailing Address - Fax:708-931-3446
Practice Address - Street 1:3754 W 111TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-4008
Practice Address - Country:US
Practice Address - Phone:773-658-5157
Practice Address - Fax:708-931-3446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-08
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care