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General NPI Number Information
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NPI Number | 1164062626
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Entity Type | Individual
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Provider Name | ANTHONY PETRARCA DC
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Gender | Male
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 270 W ARMY TRAIL RD
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City | CAROL STREAM
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State | IL
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Zip | 60188-9368
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Country | US
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Telephone | 630-517-5674
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Fax | 630-300-3702
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Provider Business Mailing Address
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Address Line | 270 W AMRY TRAIL RD
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City | CAROL STREAM
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State | IL
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Zip | 60188-9368
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Country | US
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Telephone | 630-517-5674
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Fax | 630-300-3702
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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 | 038.013496
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License Number State | IL
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