Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 038-006776 | IL |
Y | 207Q00000X | Family Doctor | 036-105286 | IL |
N | 207QS0010X | Family Doctor - Sports Medicine | 036105286 | IL |
NPI | 1083662050 |
---|---|
Provider Name | Dr. Daniel R. Di Iorio |
First Address | Long Grove, IL 60047-5292 |
Second Address | Long Grove, IL 60047-5292 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 28/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036105286 | (05) | IL |
H69691 | (02) | IL |