1649310384 NPI number — MR. IGNACIO CHAN TALOSIG PHYSICAL THERAPIST

Table of content: MR. IGNACIO CHAN TALOSIG PHYSICAL THERAPIST (NPI 1649310384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649310384 NPI number — MR. IGNACIO CHAN TALOSIG PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TALOSIG
Provider First Name:
IGNACIO
Provider Middle Name:
CHAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
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:
1649310384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13656 LAMON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESTWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60445-1833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-371-3546
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19600 LA GRANGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOKENA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60448-9321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-478-3000
Provider Business Practice Location Address Fax Number:
708-478-3007
Provider Enumeration Date:
02/08/2007

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: 225100000X , with the licence number:  070-014184 , 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: 070-014184 . This is a "STATE LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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