Provider Demographics
NPI:1104532324
Name:ULLOA, VANESSA PAULINA (DC)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:PAULINA
Last Name:ULLOA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 DOUGLAS RD # A
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7918
Mailing Address - Country:US
Mailing Address - Phone:630-608-2885
Mailing Address - Fax:
Practice Address - Street 1:1210 DOUGLAS RD # A
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7918
Practice Address - Country:US
Practice Address - Phone:630-608-2885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003370A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor