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General NPI Number Information
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NPI Number | 1568785053
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Entity Type | Individual
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Provider Name | ELVIS GABRIEL DUR LCMT
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Gender | Male
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 2914 CENTRAL ST # 16
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City | EVANSTON
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State | IL
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Zip | 60201-1237
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Country | US
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Telephone | 847-962-1324
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Fax |
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Provider Business Mailing Address
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Address Line | 9375 HAMILTON CT. #D
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City | DES PLAINES
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State | IL
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Zip | 60016
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Country | US
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Telephone | 847-962-1324
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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 | 173C00000X
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Taxonomy Name | Reflexologist
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License Number | 227.007600
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License Number State | IL
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