Provider Demographics
NPI:1639281546
Name:MINARDI CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MINARDI CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MINARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-466-7688
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-0364
Mailing Address - Country:US
Mailing Address - Phone:630-466-7688
Mailing Address - Fax:630-466-7693
Practice Address - Street 1:125 S ROUTE 47
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554
Practice Address - Country:US
Practice Address - Phone:630-466-7688
Practice Address - Fax:630-466-7693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4527418OtherBCBS PROVIDER NUMBER
IL131154OtherACN PROVIDER NUMBER
IL000798016012OtherUNITED HEALTHCARE
IL000798016012OtherUNITED HEALTHCARE