Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 038009954 | IL |
NPI | 1821070525 |
---|---|
Provider Name | Dr. Sitihiamphone Phetchamphone |
First Address | Oakbrook Terrace, IL 60181 |
Second Address | Oakbrook Terrace, IL 60181 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 14/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2232336 | BCBS (01) | IL |