Provider Demographics
NPI:1619540739
Name:GASIOR, JOSEPH PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PAUL
Last Name:GASIOR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JOE
Other - Middle Name:
Other - Last Name:GASIOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1706 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2125
Mailing Address - Country:US
Mailing Address - Phone:773-697-8088
Mailing Address - Fax:
Practice Address - Street 1:1310 W WRIGHTWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1226
Practice Address - Country:US
Practice Address - Phone:847-714-3561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013739111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician