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General NPI Number Information
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NPI Number | 1174603294
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Entity Type | Individual
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Provider Name | ROBERT J DIERINGER DC
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Gender | Male
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 19806 WOLF RD UNIT 4
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City | MOKENA
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State | IL
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Zip | 60448-1385
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Country | US
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Telephone | 708-478-0620
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Fax |
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Provider Business Mailing Address
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Address Line | 11141 W 191ST ST
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City | MOKENA
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State | IL
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Zip | 60448-9278
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Country | US
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Telephone | 708-478-0620
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Fax | 708-479-8948
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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 | 038009120
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License Number State | IL
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