Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 038005174 | IL |
NPI | 1598846305 |
---|---|
Provider Name | Dr. Bruce Vanderschaaf |
First Address | Oswego, IL 60543-9040 |
Second Address | Oswego, IL 60543-9040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T38407 | (02) | IL |