=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144372830
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA ELLEN CALDARELLA D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 09/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1731 N MARCEY ST SUITE 530
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60614-5373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-852-7850
-----------------------------------------------------
Fax | 312-787-7853
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 122 S MICHIGAN AVE SUITE 1560
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60603-6191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-939-4121
-----------------------------------------------------
Fax | 312-939-8011
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038-006148
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------