Provider Demographics
NPI:1689786683
Name:MINARDI, JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MINARDI
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: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 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
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
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
IL4527418OtherBCBS PROVIDER NUMBER
IL131154OtherACN GROUP PROVIDER NUMBER
IL131154OtherACN GROUP PROVIDER NUMBER