Healthcare Provider Details

I. General information

NPI: 1780779975
Provider Name (Legal Business Name): ANTHONY PENDOLINO D.C., DIPL. ACUP.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15715 S ROUTE 59
PLAINFIELD IL
60544
US

IV. Provider business mailing address

15715 S ROUTE 59
PLAINFIELD IL
60544
US

V. Phone/Fax

Practice location:
  • Phone: 815-436-1191
  • Fax: 815-436-1296
Mailing address:
  • Phone: 815-436-1191
  • Fax: 815-436-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-007415
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198-00373
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: