Provider Demographics
NPI:1548443088
Name:PROPER BALANCE HEALTHCARE
Entity type:Organization
Organization Name:PROPER BALANCE HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CREEVY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-339-5571
Mailing Address - Street 1:800 S WELLS ST STE 150
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4529
Mailing Address - Country:US
Mailing Address - Phone:312-339-5571
Mailing Address - Fax:312-280-1570
Practice Address - Street 1:800 S WELLS ST STE 150
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4529
Practice Address - Country:US
Practice Address - Phone:312-339-5571
Practice Address - Fax:312-280-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU85851Medicare UPIN