Provider Demographics
NPI:1568785053
Name:DUR, ELVIS GABRIEL (LCMT)
Entity Type:Individual
Prefix:MR
First Name:ELVIS
Middle Name:GABRIEL
Last Name:DUR
Suffix:
Gender:M
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9375 HAMILTON CT.
Mailing Address - Street 2:#D
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016
Mailing Address - Country:US
Mailing Address - Phone:847-962-1324
Mailing Address - Fax:
Practice Address - Street 1:2914 CENTRAL ST # 16
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1237
Practice Address - Country:US
Practice Address - Phone:847-962-1324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.007600173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist