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General NPI Number Information
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NPI Number | 1568691095
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Entity Type | Individual
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Provider Name | ROBERT RYAN VERCHOTA D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/06/2009
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 1600 S INDIANA AVE STE 2
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City | CHICAGO
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State | IL
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Zip | 60616-4733
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Country | US
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Telephone | 312-922-9868
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 S MICHIGAN AVE APT 214
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City | CHICAGO
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State | IL
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Zip | 60605-2956
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Country | US
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Telephone | 630-319-8183
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038.011471
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License Number State | IL
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