Provider Demographics
NPI:1033236351
Name:ROTUNDO, THERESE A (DC)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:A
Last Name:ROTUNDO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 W WISE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-3777
Mailing Address - Country:US
Mailing Address - Phone:847-352-8970
Mailing Address - Fax:847-352-9020
Practice Address - Street 1:1015 W WISE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-3777
Practice Address - Country:US
Practice Address - Phone:847-352-8970
Practice Address - Fax:847-352-9020
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38-004284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT37597Medicare UPIN
IL662010Medicare ID - Type Unspecified