Provider Demographics
NPI:1144427352
Name:DUARTE, MANUEL A (CHIROPRACTIC PHYSICI)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:A
Last Name:DUARTE
Suffix:
Gender:M
Credentials:CHIROPRACTIC PHYSICI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 W JEFFERSON ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404
Mailing Address - Country:US
Mailing Address - Phone:815-725-8200
Mailing Address - Fax:815-730-8576
Practice Address - Street 1:707 W JEFFERSON ST
Practice Address - Street 2:SUITE F
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404
Practice Address - Country:US
Practice Address - Phone:815-725-8200
Practice Address - Fax:815-730-8576
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NS0005X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
211653OtherCORPORATION
1336296359OtherNPI CORPORATION
IL9933246OtherBCBS
ILK17590Medicare ID - Type Unspecified