Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | IL |
NPI | 1104885904 |
---|---|
Provider Name | Dr. Douglas A Traven |
First Address | Streamwood, IL 60107-0548 |
Second Address | Streamwood, IL 60107-1874 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T37197 | (02) | IL |