Provider Demographics
NPI:1780779975
Name:PENDOLINO, ANTHONY (DC, DIPL ACUP)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:PENDOLINO
Suffix:
Gender:M
Credentials:DC, DIPL ACUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15715 S ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544
Mailing Address - Country:US
Mailing Address - Phone:815-436-1191
Mailing Address - Fax:815-436-1296
Practice Address - Street 1:15715 S ROUTE 59
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544
Practice Address - Country:US
Practice Address - Phone:815-436-1191
Practice Address - Fax:815-436-1296
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198-00373171100000X
IL038-007415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5797137OtherAENTA
IL099-05743OtherBC/BS
IL318-6341OtherCIGNA
IL350039985OtherRAILROAD MEDICARE
IL200511800OtherOWCP
IL099-05743OtherBC/BS
ILU48966Medicare UPIN