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Organization
FUNCTIONALLY BALANCED BODYWORK CLINICS, LLC
Active
Organization
FUNCTIONALLY BALANCED BODYWORK CLINICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA ROSE STARK LMT, BCTMB (OWNER)
(773) 556-5333
Entity
Organization
Contact information
Practice address
3850 W 95TH ST FL 1, EVERGREEN PARK, IL 60805-2006
(708) 529-7111
(708) 843-5811
Mailing address
3850 W 95TH ST FL 1, EVERGREEN PARK, IL 60805-2006
(708) 529-7111
(708) 843-5811
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
NULL
111N00000X
Chiropractor
—
—
171100000X
Acupuncturist
—
NULL
171100000X
Acupuncturist
—
—
225200000X
Physical Therapy Assistant
—
NULL
225200000X
Physical Therapy Assistant
—
—
225700000X
Massage Therapist
—
NULL
225700000X
Massage Therapist
—
—
261Q00000X
Clinic/Center
Primary
—
NULL
Other
Enumeration date
02/08/2019
Last updated
02/08/2019
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