Ryan Kristopher Davenport, L.A.C.
Individual provider Active NPI Acupuncturist · Mundelein, IL
NPI 1649518192 · NPPES record last updated Jan 17, 2013
Key facts
- NPI
- 1649518192
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Acupuncturist 171100000X
- License
- 198.001118 (IL)
- Practice address
- 700 N Lake St
#102
Mundelein, IL 60060-1357 - Phone
- (847) 949-0063
- NPI assigned
- Jan 17, 2013
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 198.001118 | IL | MD | Acupuncturist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Center for Wellness, Inc | Acupuncturist | Past |
Accepting new patients |
| Center for Wellness Counseling & Education LTD | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 198.001118 | IL | Yes |
Addresses
Primary practice location
700 N Lake St
#102
Mundelein, IL 60060-1357
Mailing address
1537 N Arlington Heights Rd
Unit B
Arlington Heights, IL 60004-3971
Phone (815) 793-4708
Other providers in Mundelein, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.