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General NPI Number Information
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NPI Number | 1063155471
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Entity Type | Individual
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Provider Name | JOSUE DAVID ORTIZ DC
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Gender | Male
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Dates
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Enumeration Date | 04/14/2022
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | 2018 S MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60616
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Country | US
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Telephone | 312-753-3249
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Fax |
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Provider Business Mailing Address
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Address Line | 25 W RANDOLPH ST APT 707
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City | CHICAGO
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State | IL
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Zip | 60601-3514
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Country | US
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Telephone | 864-412-9459
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038.013858
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License Number State | IL
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