Provider Demographics
NPI:1457887648
Name:JENNIFER L. FOCKLER, L.AC. LLC
Entity type:Organization
Organization Name:JENNIFER L. FOCKLER, L.AC. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:FOCKLER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:312-834-7522
Mailing Address - Street 1:1030 N CLARK ST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-5467
Mailing Address - Country:US
Mailing Address - Phone:312-834-7522
Mailing Address - Fax:
Practice Address - Street 1:1030 N CLARK ST
Practice Address - Street 2:SUITE 610
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-5467
Practice Address - Country:US
Practice Address - Phone:312-834-7522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-07
Last Update Date:2017-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001259261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center