Provider Demographics
NPI:1124220520
Name:GUGLIOTTA, MICHAEL J (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:GUGLIOTTA
Suffix:
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 1:23 N LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542
Mailing Address - Country:US
Mailing Address - Phone:630-966-2637
Mailing Address - Fax:630-966-1611
Practice Address - Street 1:23 N LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542
Practice Address - Country:US
Practice Address - Phone:630-966-2637
Practice Address - Fax:630-966-1611
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009556111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU99494Medicare UPIN