Provider Demographics
NPI:1508926189
Name:LEVY, PAUL B (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:B
Last Name:LEVY
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 1:735 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4481
Mailing Address - Country:US
Mailing Address - Phone:773-254-8977
Mailing Address - Fax:773-254-8944
Practice Address - Street 1:735 W 35TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4481
Practice Address - Country:US
Practice Address - Phone:773-254-8977
Practice Address - Fax:773-254-8944
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL33-005669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01616680OtherBLUE CROSS BLUE SHIELD
ILT38669Medicare UPIN
IL761461Medicare ID - Type Unspecified