Provider Demographics
NPI:1184435778
Name:TRISKELE FUNCTIONAL & PHYSICAL MEDICINE PLLC
Entity type:Organization
Organization Name:TRISKELE FUNCTIONAL & PHYSICAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MCPARTLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-442-8940
Mailing Address - Street 1:15 S ABERDEEN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2525
Mailing Address - Country:US
Mailing Address - Phone:858-442-8940
Mailing Address - Fax:
Practice Address - Street 1:15 S ABERDEEN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2525
Practice Address - Country:US
Practice Address - Phone:858-442-8940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty