Healthcare Provider Details

I. General information

NPI: 1114143625
Provider Name (Legal Business Name): DAVID LUYANDO JR. D.C,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 E 118TH ST
CHICAGO IL
60617-7314
US

IV. Provider business mailing address

3550 E 118TH ST
CHICAGO IL
60617-7314
US

V. Phone/Fax

Practice location:
  • Phone: 773-646-9700
  • Fax: 773-646-9805
Mailing address:
  • Phone: 773-646-9700
  • Fax: 773-646-9805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: