Provider Demographics
NPI:1033619911
Name:CHICAGO DBT, LLC
Entity Type:Organization
Organization Name:CHICAGO DBT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SOTOR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:503-908-4691
Mailing Address - Street 1:3166 N LINCOLN AVE STE 214A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3119
Mailing Address - Country:US
Mailing Address - Phone:503-908-4691
Mailing Address - Fax:503-200-1146
Practice Address - Street 1:3166 N LINCOLN AVE STE 214A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3119
Practice Address - Country:US
Practice Address - Phone:503-908-4691
Practice Address - Fax:503-200-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009608103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty