Provider Demographics
NPI:1063608867
Name:NATURAL HEALTH AND LONGEVITY LLC
Entity type:Organization
Organization Name:NATURAL HEALTH AND LONGEVITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SUVARNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-348-2800
Mailing Address - Street 1:3453 N SOUTHPORT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1438
Mailing Address - Country:US
Mailing Address - Phone:773-348-3800
Mailing Address - Fax:773-345-1400
Practice Address - Street 1:3428 N SOUTHPORT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1420
Practice Address - Country:US
Practice Address - Phone:773-348-3800
Practice Address - Fax:773-348-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty