Provider Demographics
NPI:1679746739
Name:LAUREL HEALTH CENTER, INC.
Entity type:Organization
Organization Name:LAUREL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LI-MEI
Authorized Official - Middle Name:
Authorized Official - Last Name:KU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-422-1512
Mailing Address - Street 1:122 HIDDENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-2327
Mailing Address - Country:US
Mailing Address - Phone:708-422-1512
Mailing Address - Fax:708-422-1417
Practice Address - Street 1:3348 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2236
Practice Address - Country:US
Practice Address - Phone:708-422-1512
Practice Address - Fax:708-422-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01630303OtherBLUE CROSS BLUE SHIELD
200261Medicare PIN