Provider Demographics
NPI:1417776022
Name:WHALEN, JAMES P (LAC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:WHALEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 W 95TH ST STE LL6
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2592
Mailing Address - Country:US
Mailing Address - Phone:708-422-7600
Mailing Address - Fax:
Practice Address - Street 1:4700 W 95TH ST STE LL6
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2592
Practice Address - Country:US
Practice Address - Phone:708-422-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001636171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist