Healthcare Provider Details

I. General information

NPI: 1871408708
Provider Name (Legal Business Name): JOHN DUNCAN FALLON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 W CARROLL AVE
CHICAGO IL
60607-1105
US

IV. Provider business mailing address

6417 N WAYNE AVE
CHICAGO IL
60626-5115
US

V. Phone/Fax

Practice location:
  • Phone: 312-733-0883
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1597431
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: