Healthcare Provider Details

I. General information

NPI: 1700902087
Provider Name (Legal Business Name): DANIEL E VARANAUSKI D.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2731 N LINCOLN AVE
CHICAGO IL
60614-1320
US

IV. Provider business mailing address

2731 N LINCOLN AVE #1
CHICAGO IL
60614-1320
US

V. Phone/Fax

Practice location:
  • Phone: 312-698-9855
  • Fax:
Mailing address:
  • Phone: 312-698-9855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number181-000304
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number181-000304
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: