Individual
RAVEN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSAC
Contact information
Practice address
147 HARRISON ST, OAK PARK, IL 60304-1679
(708) 400-5574
(708) 613-9293
Mailing address
378 HOGAN ST, BOLINGBROOK, IL 60490-2128
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
198.001369
IL
Other
Enumeration date
05/24/2021
Last updated
05/24/2021
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