Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 38007518 | IL |
NPI | 1205968187 |
---|---|
Provider Name | Dr. Caryllon Cummings Huggins |
First Address | Lake Bluff, IL 60044-2301 |
Second Address | Lake Bluff, IL 60044-2301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U53072 | (02) | IL |