Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 038-008808 | IL |
NPI | 1053469692 |
---|---|
Provider Name | Dr. Chad D Wasson |
First Address | Naperville, IL 60563-1557 |
Second Address | Naperville, IL 60563-1557 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 21/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U75744 | (02) | IL |