Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038011970 | IL |
N | 111NR0400X | Rehabilitation Chiropractor | 038.011970 | IL |
NPI | 1184060295 |
---|---|
Provider Name | Dr. Anthony Michael Ries |
First Address | Chicago, IL 60610-7398 |
Second Address | Chicago, IL 60647-9613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2013 |
Last Update Date | 05/01/2021 |