Provider Demographics
NPI:1578974481
Name:FREGOSO, DORIS A (DC)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:A
Last Name:FREGOSO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4367 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-2826
Mailing Address - Country:US
Mailing Address - Phone:773-767-3822
Mailing Address - Fax:773-337-9106
Practice Address - Street 1:4367 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-2826
Practice Address - Country:US
Practice Address - Phone:773-767-3822
Practice Address - Fax:773-337-9106
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor