Provider Demographics
NPI:1003007774
Name:SALGADO CHAVEZ, GEORGINA (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:SALGADO CHAVEZ
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 S KEELER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-4111
Mailing Address - Country:US
Mailing Address - Phone:773-805-2248
Mailing Address - Fax:
Practice Address - Street 1:3844 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4624
Practice Address - Country:US
Practice Address - Phone:773-735-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist