Healthcare Provider Details

I. General information

NPI: 1578974481
Provider Name (Legal Business Name): DORIS A FREGOSO DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4367 S ARCHER AVE
CHICAGO IL
60632-2826
US

IV. Provider business mailing address

4367 S ARCHER AVE
CHICAGO IL
60632-2826
US

V. Phone/Fax

Practice location:
  • Phone: 773-767-3822
  • Fax: 773-337-9106
Mailing address:
  • Phone: 773-767-3822
  • Fax: 773-337-9106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012225
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: