NPIMap

Organization Active NPI

Functionally Balanced Bodywork Clinics, LLC

  • Clinic/Center
  • Evergreen Park, IL
National Provider Identifier
1497210850
Registry record updated Feb 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
FUNCTIONALLY BALANCED BODYWORK CLINICS, LLC
Practice address
3850 W 95TH St FL 1
Evergreen Park, IL 60805-2006
Phone
(708) 529-7111
Fax
(708) 843-5811
NPI assigned
Feb 8, 2019
Last updated
Feb 8, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2019

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

Authorized official

Name
Theresa Rose Stark, LMT, BCTMBNPI 1275774788
Title
Owner
Phone
(773) 556-5333

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
AcupuncturistGroup: 193200000X MULTI-SPECIALTY GROUP 171100000X
Physical Therapy AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 225200000X
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

3850 W 95TH St FL 1
Evergreen Park, IL 60805-2006

Mailing address

3850 W 95TH St FL 1
Evergreen Park, IL 60805-2006
Phone (708) 529-7111

National Provider Directory

National Provider Directory

Locations

3850 W 95th St
#1
Evergreen Park, IL 60805
Phone (708) 529-7111

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1549584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549584000000",
    "number": "1497210850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3850 W 95TH ST FL 1",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052006",
            "telephone_number": "708-529-7111",
            "fax_number": "708-843-5811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 W 95TH ST FL 1",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052006",
            "telephone_number": "708-529-7111",
            "fax_number": "708-843-5811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONALLY BALANCED BODYWORK CLINICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-08",
        "last_updated": "2019-02-08",
        "status": "A",
        "authorized_official_last_name": "STARK",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-556-5333",
        "authorized_official_credential": "LMT, BCTMB"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evergreen Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2019; 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.