Provider Demographics
NPI:1417997750
Name:GATTO, NICHOLAS JAY (DC)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:JAY
Last Name:GATTO
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 1:5010 FAIRVIEW AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515
Mailing Address - Country:US
Mailing Address - Phone:630-964-7660
Mailing Address - Fax:760-964-9478
Practice Address - Street 1:5010 FAIRVIEW AVE
Practice Address - Street 2:STE 5
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515
Practice Address - Country:US
Practice Address - Phone:630-964-7660
Practice Address - Fax:760-964-9478
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002654L111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1682733OtherBCBS
765020Medicare ID - Type Unspecified