Provider Demographics
NPI:1710088240
Name:CASTELLESE, MARIA ASSUNTA (DC CHIROPRACTOR)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ASSUNTA
Last Name:CASTELLESE
Suffix:
Gender:F
Credentials:DC CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 BIESTERFIELD ROAD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ELK GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-7300
Mailing Address - Country:US
Mailing Address - Phone:847-690-9492
Mailing Address - Fax:847-357-9181
Practice Address - Street 1:901 BIESTERFIELD ROAD
Practice Address - Street 2:SUITE 211
Practice Address - City:ELK GROVE
Practice Address - State:IL
Practice Address - Zip Code:60007-7300
Practice Address - Country:US
Practice Address - Phone:847-690-9492
Practice Address - Fax:847-357-9181
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
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
IL01622821OtherBCBS
ILK22481Medicare ID - Type Unspecified
IL01622821OtherBCBS