Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 038003379 | IL |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 038003379 | IL |
NPI | 1346207735 |
---|---|
Provider Name | Linda L Zange |
First Address | Des Plaines, IL 60018-2171 |
Second Address | Des Plaines, IL 60018-2171 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 02/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0168225337 | BLUE CROSS BLUE SHIELD (01) | |
131842 | UHC ACN (01) | |
T36477 | (02) |