Provider Demographics
NPI:1538508940
Name:NEUMANN, MARY JANE (LAC)
Entity Type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:NEUMANN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1614
Mailing Address - Country:US
Mailing Address - Phone:708-543-8726
Mailing Address - Fax:
Practice Address - Street 1:600 N KENILWORTH AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1614
Practice Address - Country:US
Practice Address - Phone:708-543-8726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000690171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist