Enlighten Holistic Medicine, LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

198.001110 Issued in IL

Legal business name

ENLIGHTEN HOLISTIC MEDICINE, LLC

Practice address

5330 W Devon Ave
Suite 5
Chicago, IL 60646-4148

Phone

(773) 682-7124

NPI assigned

Sep 11, 2014

Last updated

Sep 11, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly Mullen Desierto, L.AC.NPI 1780069831

Title

Licensed Acupuncturist

Phone

(773) 682-7124

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelly Mullen Desierto, L.AC.

  • Acupuncturist
  • Chicago, IL
  • NPI 1780069831
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1410393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410393600000",
    "number": "1215338066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5330 W DEVON AVE",
            "address_2": "SUITE 5",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606464148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5330 W DEVON AVE",
            "address_2": "SUITE 5",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606464148",
            "telephone_number": "773-682-7124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENLIGHTEN HOLISTIC MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-11",
        "last_updated": "2014-09-11",
        "status": "A",
        "authorized_official_last_name": "DESIERTO",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "MULLEN",
        "authorized_official_title_or_position": "LICENSED ACUPUNCTURIST",
        "authorized_official_telephone_number": "773-682-7124",
        "authorized_official_credential": "L.AC."
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": "IL",
            "license": "198.001110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Acupuncturist in Chicago, IL
• Providers in Chicago, IL by specialty
• Acupuncturist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.