Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 038.012102 | IL |
NPI | 1154746469 |
---|---|
Provider Name | Tanya Freseth |
First Address | Chicago, IL 60602-1903 |
Second Address | Chicago, IL 60602-1903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2014 |
Last Update Date | 24/02/2014 |