Healthcare Provider Details

I. General information

NPI: 1083662050
Provider Name (Legal Business Name): DANIEL R. DI IORIO MD, DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 SALEM LAKE DR STE F
LONG GROVE IL
60047-5292
US

IV. Provider business mailing address

3880 SALEM LAKE DR STE F
LONG GROVE IL
60047-5292
US

V. Phone/Fax

Practice location:
  • Phone: 847-719-2220
  • Fax: 847-719-2265
Mailing address:
  • Phone: 847-719-2220
  • Fax: 847-719-2265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-006776
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036105286
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-105286
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: