Provider Demographics
NPI:1376611525
Name:CALCAGNO, PASQUALE G (DC)
Entity Type:Individual
Prefix:
First Name:PASQUALE
Middle Name:G
Last Name:CALCAGNO
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 1:260 E ARMY TRAIL RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103
Mailing Address - Country:US
Mailing Address - Phone:630-830-8600
Mailing Address - Fax:630-830-2273
Practice Address - Street 1:260 E ARMY TRAIL RD
Practice Address - Street 2:SUITE D
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103
Practice Address - Country:US
Practice Address - Phone:630-830-8600
Practice Address - Fax:630-830-2273
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U65541Medicare UPIN
K18959Medicare ID - Type Unspecified