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General NPI Number Information
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NPI Number | 1619540739
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Entity Type | Individual
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Provider Name | JOSEPH PAUL GASIOR DC
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Gender | Male
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 1310 W WRIGHTWOOD AVE
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City | CHICAGO
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State | IL
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Zip | 60614-1226
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Country | US
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Telephone | 847-714-3561
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Fax |
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Provider Business Mailing Address
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Address Line | 1706 W NORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60622-2125
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Country | US
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Telephone | 773-697-8088
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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 | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 038.013739
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License Number State | IL
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