Individual
MRS. MARTINA MARIA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.AC.
Contact information
Practice address
8143 S WABASH AVE, CHICAGO, IL 60619-4705
(773) 216-3146
Mailing address
8143 S WABASH AVE, CHICAGO, IL 60619-4705
(773) 216-3146
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
198000579
IL
Other
Enumeration date
10/18/2012
Last updated
10/18/2012
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