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General NPI Number Information
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NPI Number | 1154816775
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Entity Type | Organization
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Legal Business Name | GARRETT EZELL DC PC
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 7323 NORTHGATE WAY UNIT 9
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-4058
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Country | US
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Telephone | 312-451-2707
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Fax |
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Provider Business Mailing Address
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Address Line | 6101 W WARWICK AVE
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City | CHICAGO
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State | IL
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Zip | 60634-2557
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Country | US
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Telephone | 312-451-2707
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. GARRETT PRESTON EZELL
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Credential | DC
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Telephone | 312-451-2707
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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 |
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License Number State |
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