Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 0383412 | IL |
N | 111NN1001X | Nutrition | 0383412 | IL |
NPI | 1598707333 |
---|---|
Provider Name | Dr. Gerald Thomas Andreoli |
First Address | Bloomingdale, IL 60108-1317 |
Second Address | Arlington Heights, IL 60005-1518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T36426 | (02) | IL |