Provider Demographics
NPI:1205944436
Name:DELVECCHIO, ERNEST ANTONIO (DC)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:ANTONIO
Last Name:DELVECCHIO
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 1:22 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-3514
Mailing Address - Country:US
Mailing Address - Phone:630-820-5566
Mailing Address - Fax:630-820-3066
Practice Address - Street 1:22 N UNION ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-3514
Practice Address - Country:US
Practice Address - Phone:630-820-5566
Practice Address - Fax:630-820-3066
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
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
IL213421Medicare ID - Type Unspecified
IL4515285Medicare UPIN