Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | IL |
NPI | 1164439329 |
---|---|
Provider Name | Dr. Alfred John Petrone |
First Address | Hoffman Estates, IL 60195-3726 |
Second Address | Hoffman Estates, IL 60195-3726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1621687 | BLUE CROSS BULE SHIELD (01) | IL |
T37257 | (02) | IL |