Provider Demographics
NPI:1376585265
Name:BAVARO, CHRISTA (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:
Last Name:BAVARO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CHRISTA
Other - Middle Name:
Other - Last Name:ANDREOLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1702 W CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1518
Mailing Address - Country:US
Mailing Address - Phone:847-259-4493
Mailing Address - Fax:
Practice Address - Street 1:1702 W CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1518
Practice Address - Country:US
Practice Address - Phone:847-259-4493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008349111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU69054Medicare UPIN
410780Medicare ID - Type Unspecified