Organization
BODHI & SAGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER FONG PT, LAC (FOUNDER & CLINIC DIRECTOR)
(312) 403-1853
Entity
Organization
Contact information
Practice address
1525 E 53RD ST STE 808, CHICAGO, IL 60615-4583
(312) 403-1853
(773) 947-0084
Mailing address
1525 E 53RD ST STE 808, CHICAGO, IL 60615-4583
(312) 403-1853
(773) 947-0084
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
198001289
IL
Other
Enumeration date
06/28/2018
Last updated
06/28/2018
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