Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 038-006415 | IL |
NPI | 1053491746 |
---|---|
Provider Name | Dr. Steven Robert Segal |
First Address | Libertyville, IL 60048-2886 |
Second Address | Libertyville, IL 60048-2886 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 17/01/2017 |