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Organization
DISENTANGLE LLC
Active
Organization
DISENTANGLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACLYN O'CONNELL (OWNER)
(708) 581-6487
Entity
Organization
Contact information
Practice address
11104 S KEDZIE AVE, CHICAGO, IL 60655-2330
(708) 581-6487
Mailing address
11104 S KEDZIE AVE, CHICAGO, IL 60655-2330
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
03/27/2017
Last updated
03/27/2017
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