Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 038-005798 | IL |
NPI | 1508938580 |
---|---|
Provider Name | Jacob G Caraotta |
First Address | Rockford, IL 61108-2275 |
Second Address | Rockford, IL 61108-2275 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U30871 | (02) |