Provider Demographics
NPI:1992905194
Name:MARIA A. CASTELLESE D.C., P.C.
Entity type:Organization
Organization Name:MARIA A. CASTELLESE D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ASSUNTA
Authorized Official - Last Name:CASTELLESE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-690-9492
Mailing Address - Street 1:901 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ELK GROVE VLG
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3392
Mailing Address - Country:US
Mailing Address - Phone:847-690-9492
Mailing Address - Fax:847-357-9181
Practice Address - Street 1:901 BIESTERFIELD RD
Practice Address - Street 2:SUITE 211
Practice Address - City:ELK GROVE VLG
Practice Address - State:IL
Practice Address - Zip Code:60007-3392
Practice Address - Country:US
Practice Address - Phone:847-690-9492
Practice Address - Fax:847-357-9181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty