Provider Demographics
NPI:1427713106
Name:MCNEALY, ADRIANE
Entity type:Individual
Prefix:
First Name:ADRIANE
Middle Name:
Last Name:MCNEALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 S INDIANA AVE APT 2011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2678
Mailing Address - Country:US
Mailing Address - Phone:177-356-2676
Mailing Address - Fax:
Practice Address - Street 1:230 W HURON ST STE 520
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3933
Practice Address - Country:US
Practice Address - Phone:312-818-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227015177225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist