Provider Demographics
NPI:1952746794
Name:O'TOOLE, JAMES ROBERT (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:O'TOOLE
Suffix:
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 1:600 CENTRAL AVE
Mailing Address - Street 2:SUITE 144
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3211
Mailing Address - Country:US
Mailing Address - Phone:847-266-5656
Mailing Address - Fax:847-266-5658
Practice Address - Street 1:600 CENTRAL AVE
Practice Address - Street 2:SUITE 144
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3211
Practice Address - Country:US
Practice Address - Phone:847-266-5656
Practice Address - Fax:847-266-5658
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL8149004Medicare PIN