Provider Demographics
NPI:1902914625
Name:GIRONE, MICHAEL DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:GIRONE
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 1:1850 PIGEON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:VARNA
Mailing Address - State:IL
Mailing Address - Zip Code:61375-9306
Mailing Address - Country:US
Mailing Address - Phone:309-399-7100
Mailing Address - Fax:
Practice Address - Street 1:1109 5TH ST
Practice Address - Street 2:
Practice Address - City:LACON
Practice Address - State:IL
Practice Address - Zip Code:61540-1364
Practice Address - Country:US
Practice Address - Phone:309-246-2566
Practice Address - Fax:309-246-3430
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2014-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL350049164OtherRAILROAD
IL038-007068Medicaid
IL038-007068Medicaid
IL399910Medicare ID - Type UnspecifiedMEDICARE