Provider Demographics
NPI:1073756300
Name:CARABALLO, CLAUDETTE PATRICIA (DC)
Entity Type:Individual
Prefix:
First Name:CLAUDETTE
Middle Name:PATRICIA
Last Name:CARABALLO
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 1:5316 W WAVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3353
Mailing Address - Country:US
Mailing Address - Phone:773-587-1036
Mailing Address - Fax:847-352-0423
Practice Address - Street 1:22 N UNION ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-3514
Practice Address - Country:US
Practice Address - Phone:630-820-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038011392OtherILLINOIS DIV OF PROFESSIONAL REGULATION