Provider Demographics
NPI:1073556486
Name:AGUILAR, JOSE LUIS JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:AGUILAR
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SKOKIE BLVD
Mailing Address - Street 2:STE L
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1625
Mailing Address - Country:US
Mailing Address - Phone:773-218-0097
Mailing Address - Fax:
Practice Address - Street 1:300 SKOKIE BLVD
Practice Address - Street 2:STEL
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1625
Practice Address - Country:US
Practice Address - Phone:773-218-0097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010421111N00000X
IL038.010421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor