Demetrios Bobolos, LAC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

198.001145 Issued in IL

Practice address

512 W Burlington Ave
Suite 104
La Grange, IL 60525-2221

Phone

(708) 469-7592

NPI assigned

May 1, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1398902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398902400000",
    "number": "1851701668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5757 N SHERIDAN RD",
            "address_2": "17D",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606604746",
            "telephone_number": "773-835-2626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 W BURLINGTON AVE",
            "address_2": "SUITE 104",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605252221",
            "telephone_number": "708-469-7592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOBOLOS",
        "first_name": "DEMETRIOS",
        "credential": "LAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-05-01",
        "last_updated": "2014-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "IL",
            "license": "198.001145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellie Benz, RBT
• BFB Therapeutics, LLC
• Tina Biel, ED.S, NCSP
• Beau Blakeley, DC
• Debra Babb Blakely, RN, LCPC
• Samantha Marie Boburka, PA-C
• Jerry P Bonet, D.P.M.
• Tracy Bongiorno, P.A.-C
• Christine O'Connor Bonhomme, M.D.
• Kathryn Marie Bonnstetter

• Acupuncturist in La Grange, IL
• Providers in La Grange, IL by specialty
• Acupuncturist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2014; 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.