Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038011301 | IL |
NPI | 1003042243 |
---|---|
Provider Name | Nicholas Steven Mendez |
First Address | Skokie, IL 60076-1060 |
Second Address | Skokie, IL 60076-1060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2009 |
Last Update Date | 02/06/2009 |