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General NPI Number Information
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NPI Number | 1629101324
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Entity Type | Organization
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Legal Business Name | DR. ANTHONY J. SURRUSCO, P.C.
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 10/08/2018
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Provider Practice Location Address
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Address Line | 421 PARK AVE
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City | CLARENDON HILLS
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State | IL
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Zip | 60514-2701
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Country | US
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Telephone | 630-455-0435
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Fax | 630-455-0437
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Provider Business Mailing Address
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Address Line | 421 PARK AVE
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City | CLARENDON HILLS
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State | IL
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Zip | 60514-2701
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Country | US
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Telephone | 630-455-0435
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Fax | 630-455-0437
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. ANTHONY SURRUSCO
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Credential |
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Telephone | 630-455-0435
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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 | 038006816
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License Number State | IL
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