Provider Demographics
NPI:1295191781
Name:DE BIASIO, DANIEL ADDISON (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ADDISON
Last Name:DE BIASIO
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 1:9901 W 145TH PL
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2476
Mailing Address - Country:US
Mailing Address - Phone:708-256-5591
Mailing Address - Fax:
Practice Address - Street 1:10059 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1691
Practice Address - Country:US
Practice Address - Phone:708-598-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010360111N00000X
IL38013052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor