Healthcare Provider Details

I. General information

NPI: 1518069178
Provider Name (Legal Business Name): NICK A. LOCOCO RKT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

IV. Provider business mailing address

4181 S EMERALD AVE
CHICAGO IL
60609-2646
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-6388
  • Fax:
Mailing address:
  • Phone: 312-388-6781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: