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General NPI Number Information
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NPI Number | 1205805017
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Entity Type | Individual
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Provider Name | JUSTIN A SJOVALL M.ED, ATC
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Gender | Male
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3225 W FOSTER AVE BOX 25
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City | CHICAGO
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State | IL
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Zip | 60625-4823
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Country | US
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Telephone | 773-244-5682
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Fax |
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Provider Business Mailing Address
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Address Line | 3118 N CLIFTON AVE APT. 2F
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City | CHICAGO
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State | IL
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Zip | 60657-3370
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Country | US
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Telephone | 773-244-5682
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | IL
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