Provider Demographics
NPI:1316288137
Name:FURMANEK, KELLY (DIPL OM)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:FURMANEK
Suffix:
Gender:F
Credentials:DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2341
Mailing Address - Country:US
Mailing Address - Phone:312-401-1185
Mailing Address - Fax:
Practice Address - Street 1:10059 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1560
Practice Address - Country:US
Practice Address - Phone:708-598-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000885171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist