Provider Demographics
NPI:1467921080
Name:GALAN, JOHN NESTLE ESLOFOR
Entity Type:Individual
Prefix:
First Name:JOHN NESTLE
Middle Name:ESLOFOR
Last Name:GALAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5752 N AUSTIN AVE # 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6231
Mailing Address - Country:US
Mailing Address - Phone:708-274-6193
Mailing Address - Fax:
Practice Address - Street 1:5752 N AUSTIN AVE # 2N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6231
Practice Address - Country:US
Practice Address - Phone:708-274-6193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022730208100000X, 225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation