Provider Demographics
NPI:1194337857
Name:HOLISTIC EUTOPIA LLC
Entity type:Organization
Organization Name:HOLISTIC EUTOPIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEMBALA SEHR
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:847-696-6280
Mailing Address - Street 1:1191 E HIGGINS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-1563
Mailing Address - Country:US
Mailing Address - Phone:847-696-6280
Mailing Address - Fax:
Practice Address - Street 1:1191 E HIGGINS RD STE 201
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-1563
Practice Address - Country:US
Practice Address - Phone:847-696-6280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-23
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service