Provider Demographics
NPI:1467600312
Name:GHISELLI, ERIC R (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:R
Last Name:GHISELLI
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 1:2936 N RACINE AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4236
Mailing Address - Country:US
Mailing Address - Phone:765-532-5981
Mailing Address - Fax:
Practice Address - Street 1:2936 N RACINE AVE APT 1F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4236
Practice Address - Country:US
Practice Address - Phone:765-532-5981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor