Provider Demographics
NPI:1982092607
Name:VELAZQUEZ, MILADY (DN)
Entity Type:Individual
Prefix:DR
First Name:MILADY
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3312
Mailing Address - Country:US
Mailing Address - Phone:773-392-3695
Mailing Address - Fax:
Practice Address - Street 1:2622 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5683
Practice Address - Country:US
Practice Address - Phone:773-392-3695
Practice Address - Fax:872-802-4107
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181.000388172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172P00000XOther Service ProvidersNaprapathGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
133N00000XOtherNUTRITIONIST
IL181.000388OtherNAPRAPATHY
IN208100000XOtherPHYSICAL MEDICINE & REHABILITATION
IL3861571OtherNAPRAPATHY
IL172P00000XOtherNAPRAPATHY
IL174400000XOtherSPECIALIST
IL204C00000XOtherNEUROMUSCULOSKELETAL MEDICINE, SPORTS MEDICINE