Provider Demographics
NPI:1457773202
Name:GATSINOS, EFFIE (DC)
Entity Type:Individual
Prefix:
First Name:EFFIE
Middle Name:
Last Name:GATSINOS
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 1:507 S LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6740
Mailing Address - Country:US
Mailing Address - Phone:708-354-9599
Mailing Address - Fax:708-354-9799
Practice Address - Street 1:507 S LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6740
Practice Address - Country:US
Practice Address - Phone:708-354-9599
Practice Address - Fax:708-354-9799
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor