Provider Demographics
NPI:1306573282
Name:MADVITALITY ACUPUNCTURE & WELLNESS PLLC
Entity type:Organization
Organization Name:MADVITALITY ACUPUNCTURE & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF ACUPUNCTURE
Authorized Official - Prefix:DR
Authorized Official - First Name:MADALEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DACM, LAC
Authorized Official - Phone:779-456-6989
Mailing Address - Street 1:105 N OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1364
Mailing Address - Country:US
Mailing Address - Phone:779-456-6989
Mailing Address - Fax:
Practice Address - Street 1:105 N OAK PARK AVE STE 4C
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1364
Practice Address - Country:US
Practice Address - Phone:779-456-6989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service