Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | IL | |
N | 111NX0800X | Chiropractor Orthopedic Specialist | IL |
NPI | 1144427352 |
---|---|
Provider Name | Manuel A Duarte |
First Address | Shorewood, IL 60404 |
Second Address | Shorewood, IL 60404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1336296359 | NPI CORPORATION (01) | |
211653 | CORPORATION (01) | |
9933246 | BCBS (01) | IL |