Provider Demographics
NPI:1609391812
Name:PANGAN, CHRISTIAN JOY LAZARO
Entity Type:Individual
Prefix:
First Name:CHRISTIAN JOY
Middle Name:LAZARO
Last Name:PANGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 CHICK EVANS ST
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-2075
Mailing Address - Country:US
Mailing Address - Phone:630-456-0389
Mailing Address - Fax:
Practice Address - Street 1:306 CHICK EVANS ST
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490
Practice Address - Country:US
Practice Address - Phone:630-456-0389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.022797225100000X
IL070022797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty