Provider Demographics
NPI:1194762112
Name:AMBROSINO, NUNZIO J (DC)
Entity type:Individual
Prefix:DR
First Name:NUNZIO
Middle Name:J
Last Name:AMBROSINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1634 S SURREY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3707
Mailing Address - Country:US
Mailing Address - Phone:847-427-9526
Mailing Address - Fax:847-427-4663
Practice Address - Street 1:150 E HURON ST
Practice Address - Street 2:SUITE 805
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2999
Practice Address - Country:US
Practice Address - Phone:312-649-6565
Practice Address - Fax:312-649-9842
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004365111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU18753Medicare UPIN
IL212098Medicare ID - Type Unspecified