Provider Demographics
NPI:1902812423
Name:SANTOLIN, STEVEN M (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:SANTOLIN
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 1:2145 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6621
Mailing Address - Country:US
Mailing Address - Phone:815-744-4442
Mailing Address - Fax:815-744-2985
Practice Address - Street 1:2145 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6621
Practice Address - Country:US
Practice Address - Phone:815-744-4442
Practice Address - Fax:815-744-2985
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-3800187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
363800187OtherFEDERAL TAX ID
9982043OtherBLUE CROSS ID
U27596Medicare UPIN
964650Medicare ID - Type Unspecified