Provider Demographics
NPI:1932730058
Name:MACHADO, JULIAN (DC)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:
Last Name:MACHADO
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 1:360 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3244
Mailing Address - Country:US
Mailing Address - Phone:815-838-9441
Mailing Address - Fax:815-838-3401
Practice Address - Street 1:360 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3244
Practice Address - Country:US
Practice Address - Phone:815-838-9441
Practice Address - Fax:815-838-3401
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013479111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty