Provider Demographics
NPI:1407122039
Name:DOBSON, DEON (ATC)
Entity Type:Individual
Prefix:
First Name:DEON
Middle Name:
Last Name:DOBSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7306 S WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60636-3738
Mailing Address - Country:US
Mailing Address - Phone:773-517-8618
Mailing Address - Fax:
Practice Address - Street 1:205 W WACKER DR STE 1020
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-1452
Practice Address - Country:US
Practice Address - Phone:312-423-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer