Provider Demographics
NPI:1598707333
Name:ANDREOLI, GERALD THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:THOMAS
Last Name:ANDREOLI
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 1:224 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1317
Mailing Address - Country:US
Mailing Address - Phone:847-259-4493
Mailing Address - Fax:847-259-2242
Practice Address - Street 1:1702 W CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1518
Practice Address - Country:US
Practice Address - Phone:847-259-4493
Practice Address - Fax:847-259-2242
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0383412111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT36426Medicare UPIN
IL445540Medicare ID - Type Unspecified