Provider Demographics
NPI:1598795569
Name:VENTURINI, PAUL R (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:VENTURINI
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 1:2060 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-6630
Mailing Address - Country:US
Mailing Address - Phone:217-787-8200
Mailing Address - Fax:217-787-8899
Practice Address - Street 1:2060 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-6630
Practice Address - Country:US
Practice Address - Phone:217-787-8200
Practice Address - Fax:217-787-8899
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203968Medicare ID - Type Unspecified
ILT87085Medicare UPIN