Individual
JOHNEIL TORENA JUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
33707 N LAKE SHORE DR, GAGES LAKE, IL 60030-1748
(847) 521-9559
Mailing address
33707 LAKE SHORE DRIVE, GAGES LAKE, IL 60030
(847) 521-9559
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227008214
IL
Other
Enumeration date
04/29/2009
Last updated
04/29/2009
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