Individual
DALE EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7300 S ASHLAND AVE # 1, CHICAGO, IL 60636-4018
(773) 424-4346
Mailing address
7300 S ASHLAND AVE # 1, CHICAGO, IL 60636-4018
(773) 424-4346
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
E15216758147
IL
Other
Enumeration date
11/04/2015
Last updated
10/27/2021
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