Individual
RICHARD MADDOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
320 OTTAWA DR, BOLINGBROOK, IL 60440-1888
(313) 720-4139
Mailing address
320 OTTAWA DR, BOLINGBROOK, IL 60440-1888
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
198001515
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
198001515
LICENSE NUMBER IL
IL
Enumeration date
12/05/2020
Last updated
12/05/2020
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