Provider Demographics
NPI:1528567559
Name:DELVICARIO, JONATHAN (DC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:DELVICARIO
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 1:1400 W NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-1837
Mailing Address - Country:US
Mailing Address - Phone:847-496-4567
Mailing Address - Fax:
Practice Address - Street 1:1400 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-1837
Practice Address - Country:US
Practice Address - Phone:847-496-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor