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General NPI Number Information
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NPI Number | 1528271079
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Entity Type | Organization
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Legal Business Name | 6 DEGREES OF FREEDOM, LLC
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1119 E ILLINOIS ST
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City | WHEATON
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State | IL
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Zip | 60187-5746
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Country | US
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Telephone | 630-752-9670
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Fax | 630-752-9672
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Provider Business Mailing Address
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Address Line | 20 DANADA SQ W #255
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City | WHEATON
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State | IL
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Zip | 60187-1000
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Country | US
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Telephone | 630-752-9670
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Fax | 630-752-9672
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARMEN P DIGIOVINE
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Credential | PH.D., RET, ATP
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Telephone | 630-752-9670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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