Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NP0017X | Pediatric Chiropractor | 038012327 | IL |
NPI | 1326435272 |
---|---|
Provider Name | Dr. Angie Recendez |
First Address | Chicago, IL 60609-4040 |
Second Address | Chicago, IL 60609-4040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2015 |
Last Update Date | 06/08/2016 |