1518087063 NPI number — ANTHONY CHARLES PANTANELLA D.C.

Table of content: ANTHONY CHARLES PANTANELLA D.C. (NPI 1518087063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518087063 NPI number — ANTHONY CHARLES PANTANELLA D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PANTANELLA
Provider First Name:
ANTHONY
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518087063
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1555 BARRINGTON RD
Provider Second Line Business Mailing Address:
DOCTOR'S BUILDING ONE, SUITE 335
Provider Business Mailing Address City Name:
HOFFMAN ESTATES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60169-1144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-885-1131
Provider Business Mailing Address Fax Number:
847-839-0910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1555 BARRINGTON RD
Provider Second Line Business Practice Location Address:
BLDG. 1, STE.335
Provider Business Practice Location Address City Name:
HOFFMAN ESTATES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60169-1144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-885-1131
Provider Business Practice Location Address Fax Number:
847-839-0910
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NI0900X , with the licence number:  038-005177 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0001636402 . This is a "BLUE SHIELD PROVIDER #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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