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General NPI Number Information
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NPI Number | 1518274869
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Entity Type | Organization
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Legal Business Name | NEEALY TRANSPORTATION
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 09/09/2010
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Provider Practice Location Address
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Address Line | 1458 W 123RD ST
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City | CHICAGO
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State | IL
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Zip | 60643-5768
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Country | US
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Telephone | 773-412-0192
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Fax |
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Provider Business Mailing Address
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Address Line | 1458 W 123RD ST
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City | CHICAGO
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State | IL
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Zip | 60643-5768
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Country | US
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Telephone | 773-412-0192
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NIKKITA JOHNSON-NEEALY
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Credential |
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Telephone | 773-412-0192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | N40062376878
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License Number State | IL
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