Healthcare Provider Details

I. General information

NPI: 1245614882
Provider Name (Legal Business Name): MAAME AMPONSAH D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 W 95TH ST
EVERGREEN PARK IL
60805
US

IV. Provider business mailing address

1000 BURR RIDGE PKWY STE 200
BURR RIDGE IL
60527-0845
US

V. Phone/Fax

Practice location:
  • Phone: 630-920-4670
  • Fax: 630-920-4687
Mailing address:
  • Phone: 630-920-4670
  • Fax: 630-920-4687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012840
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: