Provider Demographics
NPI:1730153917
Name:SANTOLIVA, VARSOVIA (DC)
Entity type:Individual
Prefix:DR
First Name:VARSOVIA
Middle Name:
Last Name:SANTOLIVA
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:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-0554
Mailing Address - Country:US
Mailing Address - Phone:708-385-9001
Mailing Address - Fax:773-767-3944
Practice Address - Street 1:12757 W WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406
Practice Address - Country:US
Practice Address - Phone:708-385-9001
Practice Address - Fax:773-767-3944
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02227830OtherBC/BS PROVIDER #
IL02227830OtherBC/BS PROVIDER #
IL214084Medicare PIN