Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 038004365 | IL |
NPI | 1194762112 |
---|---|
Provider Name | Dr. Nunzio J Ambrosino |
First Address | Arlington Heights, IL 60005-3707 |
Second Address | Chicago, IL 60611-2999 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 29/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U18753 | (02) | IL |