Provider Demographics
NPI:1780757989
Name:IADAROLA, VINCE (DC)
Entity type:Individual
Prefix:
First Name:VINCE
Middle Name:
Last Name:IADAROLA
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 1:261 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-4001
Mailing Address - Country:US
Mailing Address - Phone:630-833-4069
Mailing Address - Fax:
Practice Address - Street 1:222 N WESTERN AVE STE A
Practice Address - Street 2:
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110-1780
Practice Address - Country:US
Practice Address - Phone:847-844-1950
Practice Address - Fax:847-844-1489
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL16-82648OtherBCBS PROVIDER NUMBER
IL16-82648OtherBCBS PROVIDER NUMBER