Healthcare Provider Details

I. General information

NPI: 1144609488
Provider Name (Legal Business Name): SADEGH MILAD ASEFI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 10TH AVE E
MILAN IL
61264
US

IV. Provider business mailing address

1929 10TH AVE E
MILAN IL
61264-2953
US

V. Phone/Fax

Practice location:
  • Phone: 309-787-2600
  • Fax:
Mailing address:
  • Phone: 309-787-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number077145
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: