Healthcare Provider Details

I. General information

NPI: 1417997750
Provider Name (Legal Business Name): NICHOLAS JAY GATTO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 FAIRVIEW AVE STE 5
DOWNERS GROVE IL
60515
US

IV. Provider business mailing address

5010 FAIRVIEW AVE STE 5
DOWNERS GROVE IL
60515
US

V. Phone/Fax

Practice location:
  • Phone: 630-964-7660
  • Fax: 760-964-9478
Mailing address:
  • Phone: 630-964-7660
  • Fax: 760-964-9478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC002654L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: