Provider Demographics
NPI:1366639056
Name:PANZO, JOSEPH J (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:PANZO
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 1:6614 S HALSTED ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-1812
Mailing Address - Country:US
Mailing Address - Phone:773-783-0303
Mailing Address - Fax:773-783-2300
Practice Address - Street 1:6614 S HALSTED ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-1812
Practice Address - Country:US
Practice Address - Phone:773-783-0303
Practice Address - Fax:773-783-2300
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL300600OtherMEDICARE PART B
IL01608208OtherBLUE CROSS/BLUE SHIELD
IL01633482OtherBLUE SHIELD
U67020Medicare UPIN