=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902812423
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN M SANTOLIN D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2006
-----------------------------------------------------
Last Update Date | 04/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2145 W JEFFERSON ST
-----------------------------------------------------
City | JOLIET
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60435-6621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-744-4442
-----------------------------------------------------
Fax | 815-744-2985
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2145 W JEFFERSON ST
-----------------------------------------------------
City | JOLIET
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60435-6621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-744-4442
-----------------------------------------------------
Fax | 815-744-2985
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 36-3800187
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------