Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 0038008429 | IL |
NPI | 1003107350 |
---|---|
Provider Name | Dr. Lisa Marie Borgealt |
First Address | Downers Grove, IL 60515-1950 |
Second Address | Lombard, IL 60148-5317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2011 |
Last Update Date | 20/04/2011 |