Provider Demographics
NPI:1780690719
Name:SPALLA, JOHN THOMAS (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:SPALLA
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 1:5618 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1304
Mailing Address - Country:US
Mailing Address - Phone:708-423-0004
Mailing Address - Fax:708-529-7163
Practice Address - Street 1:5618 W 79TH ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1304
Practice Address - Country:US
Practice Address - Phone:708-423-0004
Practice Address - Fax:708-529-7163
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008995111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U84857Medicare UPIN