Provider Demographics
NPI:1376951327
Name:PAULUS, NATHAN JOHN (LMT, ABT)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:JOHN
Last Name:PAULUS
Suffix:
Gender:M
Credentials:LMT, ABT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2043 N SAWYER AVE
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5807
Mailing Address - Country:US
Mailing Address - Phone:773-292-1688
Mailing Address - Fax:
Practice Address - Street 1:1834 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1312
Practice Address - Country:US
Practice Address - Phone:773-227-9150
Practice Address - Fax:773-227-9160
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.013548225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist