=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932410990
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANEL V. CHUA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2010
-----------------------------------------------------
Last Update Date | 06/24/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4538 N BEACON ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60640-5519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-561-4134
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5244 SUFFIELD TER
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60077-1565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-205-1544
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 070017761
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------