Provider Demographics
NPI:1548725872
Name:GANDOLFI, CHARLES FRANCIS III (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FRANCIS
Last Name:GANDOLFI
Suffix:III
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 1:450 N SEYMOUR AVE
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1835
Mailing Address - Country:US
Mailing Address - Phone:847-949-4262
Mailing Address - Fax:
Practice Address - Street 1:450 N SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1835
Practice Address - Country:US
Practice Address - Phone:847-949-4262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor