Healthcare Provider Details

I. General information

NPI: 1699001578
Provider Name (Legal Business Name): DANA R BALDINO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W US HIGHWAY 20 SUITE 201
PINGREE GROVE IL
60140-8818
US

IV. Provider business mailing address

2401 W US HIGHWAY 20 SUITE 201
PINGREE GROVE IL
60140-8818
US

V. Phone/Fax

Practice location:
  • Phone: 847-453-4953
  • Fax: 847-456-4932
Mailing address:
  • Phone: 847-453-4953
  • Fax: 847-453-4932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-011528
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: