Organization
BODHI & SAGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROGER FONG MPT, LAC (MEMBER)
(312) 403-1853
Entity
Organization
Contact information
Practice address
1525 E 53RD ST STE 808, CHICAGO, IL 60615-4583
(312) 403-1853
Mailing address
1525 E 53RD ST STE 808, CHICAGO, IL 60615-4583
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
070013559
IL
Other
Enumeration date
12/04/2015
Last updated
12/08/2015
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