Provider Demographics
NPI:1164439329
Name:PETRONE, ALFRED JOHN (DC, DABCO)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:JOHN
Last Name:PETRONE
Suffix:
Gender:M
Credentials:DC, DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 W HIGGINS RD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3726
Mailing Address - Country:US
Mailing Address - Phone:847-885-8820
Mailing Address - Fax:847-885-9578
Practice Address - Street 1:275 W HIGGINS RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60195-3726
Practice Address - Country:US
Practice Address - Phone:847-885-8820
Practice Address - Fax:847-885-9578
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1621687OtherBLUE CROSS BULE SHIELD
ILT37257Medicare UPIN
IL212818Medicare ID - Type UnspecifiedMEDICARE