Provider Demographics
NPI:1588876510
Name:GUTIERREZ, VICTOR P (DC)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:P
Last Name:GUTIERREZ
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 1:8333 W MAYNARD RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1057
Mailing Address - Country:US
Mailing Address - Phone:847-987-3066
Mailing Address - Fax:773-697-4274
Practice Address - Street 1:1824 W. 47TH ST.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609
Practice Address - Country:US
Practice Address - Phone:773-890-1726
Practice Address - Fax:773-890-1203
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00376863Medicare PIN