Provider Demographics
NPI:1689606279
Name:FICARO, DONNA (DC)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:FICARO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 W 152ND PL
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-6668
Mailing Address - Country:US
Mailing Address - Phone:708-214-1123
Mailing Address - Fax:
Practice Address - Street 1:9641 W 153RD ST
Practice Address - Street 2:SUITE 48
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3775
Practice Address - Country:US
Practice Address - Phone:708-403-0431
Practice Address - Fax:708-403-0699
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-003987111NX0800X
IL164.006123133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT37653Medicare UPIN
ILNG-1669270Medicare ID - Type Unspecified