Provider Demographics
NPI:1255399572
Name:SANTIAGO, JOE L (DC)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:L
Last Name:SANTIAGO
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 1:16430 MAYORS ROW
Mailing Address - Street 2:
Mailing Address - City:ORLAND HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60477-5641
Mailing Address - Country:US
Mailing Address - Phone:708-364-7925
Mailing Address - Fax:708-364-7926
Practice Address - Street 1:645 E NEW YORK ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-3546
Practice Address - Country:US
Practice Address - Phone:630-375-1604
Practice Address - Fax:630-375-1608
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor