Provider Demographics
NPI:1134253164
Name:MORANTZ, JEROLD I (DC)
Entity type:Individual
Prefix:DR
First Name:JEROLD
Middle Name:I
Last Name:MORANTZ
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 1:16545 HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-6108
Mailing Address - Country:US
Mailing Address - Phone:708-331-3329
Mailing Address - Fax:708-331-2910
Practice Address - Street 1:16545 HALSTED ST
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-6108
Practice Address - Country:US
Practice Address - Phone:708-331-3329
Practice Address - Fax:708-331-2910
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-003550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL350018179OtherRAILROAD MEDICARE
IL01682402OtherBLUE CROSS BLUE SHIELD
IL608560-35Medicare ID - Type Unspecified
IL350018179OtherRAILROAD MEDICARE