Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | IL |
NPI | 1134215718 |
---|---|
Provider Name | Martin Albert Massari |
First Address | Melrose Park, IL 60160-1603 |
Second Address | Melrose Park, IL 60160-1603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |