Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038.012305 | IL |
N | 175F00000X | Naturopath | 099.0090563 | VT |
NPI | 1154660173 |
---|---|
Provider Name | Melissa Dybala |
First Address | Wheaton, IL 60187-5263 |
Second Address | Wheaton, IL 60187-5263 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2013 |
Last Update Date | 04/11/2013 |