Provider Demographics
NPI:1285754952
Name:PISANI, DAVID M (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:PISANI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7017 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2201
Mailing Address - Country:US
Mailing Address - Phone:773-229-0350
Mailing Address - Fax:773-229-0355
Practice Address - Street 1:7017 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2201
Practice Address - Country:US
Practice Address - Phone:773-229-0350
Practice Address - Fax:773-229-0355
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01605501OtherBCBSIL PROVIDER NUMBER
IL01605501OtherBCBSIL PROVIDER NUMBER