Provider Demographics
NPI:1982057519
Name:ROESSLER, DELL SR (LAC)
Entity Type:Individual
Prefix:MR
First Name:DELL
Middle Name:
Last Name:ROESSLER
Suffix:SR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 LARKIN AVE
Mailing Address - Street 2:SUITE 25
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5845
Mailing Address - Country:US
Mailing Address - Phone:847-888-3133
Mailing Address - Fax:847-888-3136
Practice Address - Street 1:2090 LARKIN AVE
Practice Address - Street 2:SUITE 25
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5845
Practice Address - Country:US
Practice Address - Phone:847-888-3133
Practice Address - Fax:847-888-3136
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000214171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist