Provider Demographics
NPI:1336306059
Name:KAPOTAS, KANELLA M (DC)
Entity Type:Individual
Prefix:DR
First Name:KANELLA
Middle Name:M
Last Name:KAPOTAS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 BRIARGATE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-2227
Mailing Address - Country:US
Mailing Address - Phone:847-488-1600
Mailing Address - Fax:847-488-1611
Practice Address - Street 1:460 BRIARGATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-2227
Practice Address - Country:US
Practice Address - Phone:847-488-1600
Practice Address - Fax:847-488-1611
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor