Provider Demographics
NPI:1306971718
Name:BARTOLI CHIROPRACTIC CENTER, LTD
Entity type:Organization
Organization Name:BARTOLI CHIROPRACTIC CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DARRYL
Authorized Official - Last Name:MARTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-672-2176
Mailing Address - Street 1:119 S STERLING ST
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-3015
Mailing Address - Country:US
Mailing Address - Phone:815-672-2176
Mailing Address - Fax:815-672-2177
Practice Address - Street 1:119 S STERLING ST
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-3015
Practice Address - Country:US
Practice Address - Phone:815-672-2176
Practice Address - Fax:815-672-2177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU75410Medicare UPIN
IL545350Medicare ID - Type Unspecified