Healthcare Provider Details

I. General information

NPI: 1326390923
Provider Name (Legal Business Name): TINNIRELLO CHIROPRACTIC & FAMILY WELLNESS CLINIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2827 HARLEM AVE
BERWYN IL
60402-2825
US

IV. Provider business mailing address

2827 HARLEM AVE
BERWYN IL
60402-2825
US

V. Phone/Fax

Practice location:
  • Phone: 708-317-9191
  • Fax:
Mailing address:
  • Phone: 708-317-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: PIETRO TINNIRELLO
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 630-709-4225