Provider Demographics
NPI:1710928056
Name:REVELLO, JOHN W (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:REVELLO
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 1:14406 JOHN HUMPHREY DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2638
Mailing Address - Country:US
Mailing Address - Phone:708-364-0638
Mailing Address - Fax:708-364-9805
Practice Address - Street 1:14406 JOHN HUMPHREY DRIVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462
Practice Address - Country:US
Practice Address - Phone:708-364-0638
Practice Address - Fax:708-364-9805
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK17700Medicare ID - Type Unspecified
ILK19000Medicare ID - Type Unspecified
ILV04614Medicare UPIN