Organization Active NPI

Iatgw

  • Chiropractor
  • Lake Zurich, IL
National Provider Identifier
1508077074
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
IATGW
Practice address
765 Ela Rd
Suite 105
Lake Zurich, IL 60047-2385
Phone
(847) 550-1115
Fax
(847) 550-1117
NPI assigned
May 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mary T.M. Dicerbo, D.C.
Title
Owner
Phone
(847) 550-1115

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X IL Primary

Addresses

Primary practice location

765 Ela Rd
Suite 105
Lake Zurich, IL 60047-2385

Mailing address

765 Ela Rd
Suite 105
Lake Zurich, IL 60047-2385
Phone (847) 550-1115

Other names 1

  • Wellness from the Inside Out Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508077074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "765 ELA RD",
            "address_2": "SUITE 105",
            "city": "LAKE ZURICH",
            "state": "IL",
            "postal_code": "600472385",
            "telephone_number": "847-550-1115",
            "fax_number": "847-550-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "765 ELA RD",
            "address_2": "SUITE 105",
            "city": "LAKE ZURICH",
            "state": "IL",
            "postal_code": "600472385",
            "telephone_number": "847-550-1115",
            "fax_number": "847-550-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IATGW",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DICERBO",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "T.M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-550-1115",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellness from the Inside Out",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Zurich, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.