Provider Demographics
NPI:1336149681
Name:TADROS, MARYANN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:
Last Name:TADROS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MANCHESTER RD
Mailing Address - Street 2:BLDG B STE 1075B
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3581
Mailing Address - Country:US
Mailing Address - Phone:630-221-9700
Mailing Address - Fax:630-221-9704
Practice Address - Street 1:2100 MANCHESTER RD
Practice Address - Street 2:BLDG B STE 1075B
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3581
Practice Address - Country:US
Practice Address - Phone:630-221-9700
Practice Address - Fax:630-221-9704
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2021-02-19
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
ILIL 038-008501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038-008501Medicaid
ILU72522Medicare UPIN
IL038-008501Medicaid