Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 21-570 | IL |
NPI | 1043382583 |
---|---|
Provider Name | Dr. Robert Felix Chavez |
First Address | Bourbonnais, IL 60914-2315 |
Second Address | Bourbonnais, IL 60914-2315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/07/2007 |