Functionally Balanced Bodywork Clinics, LLC

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

Organization subpart

No

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

Authorized official

Name

Theresa Rose Stark, LMT, BCTMB

Title

Owner

Phone

(773) 556-5333

Specialties & licenses 5

Addresses

Locations

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": []
}

• Elizabeth A Fritz, LCSW
• Diane E. Fronko, R.D.
• Janice M Frum, LPC, NCC
• Christopher Fry, LCSW
• Morgan Frye, DVM
• Ana Fung-Cap, D.O.
• G & B Drugs
• Paul M. Gabriel, M.D.
• Colleen T. Gaffney, DDS
• Meghan E Gaffney, DDS

• Clinic/Center in Evergreen Park, IL
• Providers in Evergreen Park, IL by specialty
• Clinic/Center in Illinois

• 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.