Organization
IATGW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY T.M. DICERBO D.C. (OWNER)
(847) 550-1115
Entity
Organization
Contact information
Practice address
765 ELA RD, SUITE 105, LAKE ZURICH, IL 60047-2385
(847) 550-1115
(847) 550-1117
Mailing address
765 ELA RD, SUITE 105, LAKE ZURICH, IL 60047-2385
(847) 550-1115
(847) 550-1117
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
Other
Enumeration date
11/13/2006
Last updated
08/22/2020
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