Provider Demographics
NPI:1114143625
Name:LUYANDO, DAVID JR (DC,)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LUYANDO
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 1:3550 E 118TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-7314
Mailing Address - Country:US
Mailing Address - Phone:773-646-9700
Mailing Address - Fax:773-646-9805
Practice Address - Street 1:3550 E 118TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-7314
Practice Address - Country:US
Practice Address - Phone:773-646-9700
Practice Address - Fax:773-646-9805
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation