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General NPI Number Information
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NPI Number | 1104532324
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Entity Type | Individual
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Provider Name | VANESSA PAULINA ULLOA D.C.
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Gender | Female
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Dates
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Enumeration Date | 01/31/2023
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 1210 DOUGLAS RD # A
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City | OSWEGO
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State | IL
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Zip | 60543-7918
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Country | US
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Telephone | 630-608-2885
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 DOUGLAS RD # A
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City | OSWEGO
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State | IL
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Zip | 60543-7918
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Country | US
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Telephone | 630-608-2885
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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 | 08003370A
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License Number State | IN
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