Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038012789 | IL |
N | 111NP0017X | Pediatric Chiropractor | 038012789 | IL |
NPI | 1376810614 |
---|---|
Provider Name | Dr. Whitney Leigh Fandel |
First Address | Park Ridge, IL 60068-1414 |
Second Address | Park Ridge, IL 60068-1356 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2011 |
Last Update Date | 01/09/2016 |