Provider Demographics
NPI:1851772834
Name:MICHELLE POLK ACUPUNCTURE
Entity type:Organization
Organization Name:MICHELLE POLK ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:847-769-3312
Mailing Address - Street 1:1479 W WINONA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-6819
Mailing Address - Country:US
Mailing Address - Phone:847-769-3312
Mailing Address - Fax:
Practice Address - Street 1:3166 N LINCOLN AVE STE 405
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3119
Practice Address - Country:US
Practice Address - Phone:847-769-3312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001227171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty