Organization
FIVE PHASE WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN LOMBARDO DAOM (WELLNESS DIRECTOR)
(847) 905-0440
Entity
Organization
Contact information
Practice address
708 MAIN ST, EVANSTON, IL 60202-1702
(847) 905-0440
Mailing address
708 MAIN ST, EVANSTON, IL 60202-1702
(847) 905-0440
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
198000495
IL
Other
Enumeration date
06/08/2011
Last updated
06/08/2011
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