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General NPI Number Information
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NPI Number | 1285747634
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Entity Type | Individual
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Provider Name | JULIAN S. CHESTNUT D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 875 NIGHT OWL LN
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City | ROSCOE
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State | IL
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Zip | 61073-7460
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Country | US
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Telephone | 815-623-3756
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Fax |
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Provider Business Mailing Address
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Address Line | 875 NIGHT OWL LN
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City | ROSCOE
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State | IL
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Zip | 61073-7460
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Country | US
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Telephone | 815-623-3756
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036-066070
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License Number State | IL
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