Provider Demographics
NPI:1376741108
Name:NYULI, JOHN M (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:NYULI
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 1:302 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2511
Mailing Address - Country:US
Mailing Address - Phone:630-584-5800
Mailing Address - Fax:630-584-6190
Practice Address - Street 1:302 S 14TH ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2511
Practice Address - Country:US
Practice Address - Phone:630-584-5800
Practice Address - Fax:630-584-6190
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4532273-1982646246OtherBLUECROSS BLUESHIELD
IL4532273-1982646246OtherBLUECROSS BLUESHIELD
IL1982646246Medicare ID - Type Unspecified