Provider Demographics
NPI:1144372830
Name:CALDARELLA, CYNTHIA ELLEN (DC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ELLEN
Last Name:CALDARELLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S MICHIGAN AVE
Mailing Address - Street 2:SUITE 1560
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-6191
Mailing Address - Country:US
Mailing Address - Phone:312-939-4121
Mailing Address - Fax:312-939-8011
Practice Address - Street 1:1731 N MARCEY ST
Practice Address - Street 2:SUITE 530
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5373
Practice Address - Country:US
Practice Address - Phone:312-852-7850
Practice Address - Fax:312-787-7853
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT39055Medicare UPIN
ILL90198Medicare ID - Type Unspecified