Provider Demographics
NPI:1548713373
Name:ORSINI, CLINTON (DC)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:
Last Name:ORSINI
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 1:555 E BUTTERFIELD RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5680
Mailing Address - Country:US
Mailing Address - Phone:262-565-3048
Mailing Address - Fax:630-541-8538
Practice Address - Street 1:555 E BUTTERFIELD RD STE 120
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5680
Practice Address - Country:US
Practice Address - Phone:305-418-5536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1548713373Medicaid