Provider Demographics
NPI:1164473963
Name:ZAVALETA, RAUL A (MD)
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:A
Last Name:ZAVALETA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2S 503 COTTONWOOD COURT
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555
Mailing Address - Country:US
Mailing Address - Phone:847-502-4068
Mailing Address - Fax:
Practice Address - Street 1:455 S ROSELLE RD
Practice Address - Street 2:STE 104
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-2971
Practice Address - Country:US
Practice Address - Phone:847-352-5511
Practice Address - Fax:847-352-5585
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor