Provider Demographics
NPI:1699117531
Name:SERENITY INTEGRATIVE MEDICINE LTD
Entity type:Organization
Organization Name:SERENITY INTEGRATIVE MEDICINE LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-756-1778
Mailing Address - Street 1:430 W ERIE ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-6914
Mailing Address - Country:US
Mailing Address - Phone:312-898-6327
Mailing Address - Fax:312-846-6817
Practice Address - Street 1:600 W FULTON ST
Practice Address - Street 2:SUITE 304
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1259
Practice Address - Country:US
Practice Address - Phone:312-756-1778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERENITY INTEGRATIVE MEDICINE LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-19
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty