Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 038-004455 | IL |
NPI | 1316940430 |
---|---|
Provider Name | Dr. Joseph F Ferstl |
First Address | Elgin, IL 60123-2019 |
Second Address | Elgin, IL 60123-2019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 18/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04582056 | BC/BS (01) | IL |
T37799 | (02) | IL |