MEDICARE: DR. EUGENE ALAN AIELLO DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	038-008380	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2222097	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1548208416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EUGENE ALAN AIELLO DC

Provider Business Mailing Address
First Line	:	7127 CROSSROADS BLVD UNIT 1
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2827
Country	:	US
Telephone Number	:	615-945-6416
Fax Number	:	630-529-0048

Provider Business Practice Location Address
First Line	:	7127 CROSSROADS BLVD STE 102
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2827
Country	:	US
Telephone Number	:	615-945-6416
Fax Number	:	630-529-0048

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	01/21/2021

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