Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 038011380 | IL |
Y | 111NR0400X | Rehabilitation Chiropractor | 038011380 | IL |
NPI | 1366683690 |
---|---|
Provider Name | Dr. John Russell Silosky |
First Address | Plainfield, IL 60544-2175 |
Second Address | Arlington Heights, IL 60005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2009 |
Last Update Date | 20/08/2018 |