Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 227.00318 | IL |
NPI | 1063898591 |
---|---|
Provider Name | Ms. Isabel Fregoso |
First Address | Chicago, IL 60641-2640 |
Second Address | Chicago, IL 60641-2640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2015 |
Last Update Date | 06/08/2015 |