Provider Demographics
NPI:1396402020
Name:BANDEMER, GIANNA (DC)
Entity Type:Individual
Prefix:DR
First Name:GIANNA
Middle Name:
Last Name:BANDEMER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:GIANNA
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARROLL
Mailing Address - State:IL
Mailing Address - Zip Code:61053-1027
Mailing Address - Country:US
Mailing Address - Phone:815-409-1573
Mailing Address - Fax:
Practice Address - Street 1:550 E BOUGHTON RD STE 150
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2189
Practice Address - Country:US
Practice Address - Phone:630-739-1791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor