Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | IL | |
N | 111NX0100X | Occupational Health | IL |
NPI | 1568548857 |
---|---|
Provider Name | Dr. Mevin J D'souza |
First Address | Chicago, IL 60608-5829 |
Second Address | Chicago, IL 60608-5829 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U51259 | (02) | IL |