Individual
MR. ENRIQUE BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
929 W HIGGINS RD, SCHAUMBURG, IL 60195-3203
(847) 885-0078
Mailing address
109 TERRA SPRINGS DR, VOLO, IL 60020-3201
(815) 814-8867
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
096-002119
IL
Other
Enumeration date
01/24/2006
Last updated
03/21/2012
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