Provider Demographics
NPI:1396758603
Name:JACOBAZZI, DANIEL JOSEPH (PT)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:JACOBAZZI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 W IRVING PARK RD
Mailing Address - Street 2:#1 W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2406
Mailing Address - Country:US
Mailing Address - Phone:773-852-3335
Mailing Address - Fax:773-751-5292
Practice Address - Street 1:1820 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2402
Practice Address - Country:US
Practice Address - Phone:773-852-3335
Practice Address - Fax:773-751-5292
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008864111N00000X
IL070018357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6350Medicare UPIN