Provider Demographics
NPI:1669739637
Name:NOTTOLI, CARL A (DC)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:A
Last Name:NOTTOLI
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 1:2101 WAUKEGAN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1836
Mailing Address - Country:US
Mailing Address - Phone:269-267-7937
Mailing Address - Fax:847-236-1195
Practice Address - Street 1:2101 WAUKEGAN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1836
Practice Address - Country:US
Practice Address - Phone:269-267-7937
Practice Address - Fax:847-236-1195
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor