Healthcare Provider Details

I. General information

NPI: 1902318694
Provider Name (Legal Business Name): GABRIELLA CHARLOTTE LAURINO DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CENTRAL AVE STE 144
HIGHLAND PARK IL
60035-5604
US

IV. Provider business mailing address

600 CENTRAL AVE STE 144
HIGHLAND PARK IL
60035-5604
US

V. Phone/Fax

Practice location:
  • Phone: 847-266-5656
  • Fax:
Mailing address:
  • Phone: 847-266-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number038.013165
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: