Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | 038-005498 | IL |
N | 111NR0400X | Rehabilitation Chiropractor | 038005498 | IL |
Y | 111NS0005X | Chiropractic Sports Physician | 038-005498 | IL |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 038-005498 | IL |
NPI | 1063685246 |
---|---|
Provider Name | Dr. Thomas Burton Sperry |
First Address | Downers Grove, IL 60515-1708 |
Second Address | Downers Grove, IL 60515-1708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2008 |
Last Update Date | 06/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
$$$$$$$$$ | (02) | IL |