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
—
—
171100000X
Acupuncturist
—
—
225200000X
Physical Therapy Assistant
—
—
225700000X
Massage Therapist
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
02/08/2019
Last updated
02/08/2019
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