Healthcare Provider Details

I. General information

NPI: 1508926189
Provider Name (Legal Business Name): PAUL B LEVY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 W 35TH ST
CHICAGO IL
60616-4481
US

IV. Provider business mailing address

735 W 35TH ST
CHICAGO IL
60616-4481
US

V. Phone/Fax

Practice location:
  • Phone: 773-254-8977
  • Fax: 773-254-8944
Mailing address:
  • Phone: 773-254-8977
  • Fax: 773-254-8944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33-005669
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: