Provider Demographics
NPI:1447291026
Name:GAROFOLA, CHAD M (DC)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:M
Last Name:GAROFOLA
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 1:2040 N DAMEN AVE FRNT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6020
Mailing Address - Country:US
Mailing Address - Phone:773-772-1010
Mailing Address - Fax:773-772-3252
Practice Address - Street 1:2040 N DAMEN AVE FRNT
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6020
Practice Address - Country:US
Practice Address - Phone:773-772-1010
Practice Address - Fax:773-772-3252
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV04515Medicare UPIN
ILK17555Medicare ID - Type Unspecified
ILK18991Medicare ID - Type Unspecified