Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038.013437 | IL |
NPI | 1003467804 |
---|---|
Provider Name | Dr. Dino Gerald O'mara |
First Address | Chicago, IL 60655-2221 |
Second Address | Chicago, IL 60655-2221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2019 |
Last Update Date | 01/04/2020 |