Healthcare Provider Details

I. General information

NPI: 1922365048
Provider Name (Legal Business Name): STEVEN PALIAKAS DC PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S COUNTY FARM RD SUITE E
WHEATON IL
60187-4523
US

IV. Provider business mailing address

301 S COUNTY FARM RD SUITE E
WHEATON IL
60187-4523
US

V. Phone/Fax

Practice location:
  • Phone: 815-274-7459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number038009278
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEVEN THOMAS PALIAKAS
Title or Position: DOCTOR/OWNER
Credential: D.C.
Phone: 815-274-7459