Provider Demographics
NPI:1215392428
Name:MACGLASHAN, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:MACGLASHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2804
Mailing Address - Country:US
Mailing Address - Phone:312-344-1384
Mailing Address - Fax:312-344-1457
Practice Address - Street 1:1509 S STATE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2804
Practice Address - Country:US
Practice Address - Phone:312-344-1384
Practice Address - Fax:312-344-1457
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001228171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist