Individual
LOUIS THOMAS DISTASIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.AC.
Contact information
Practice address
716 S 2ND ST., SPRINGFIELD, IL 62704
(217) 544-8118
(217) 544-8008
Mailing address
716 S 2ND ST., SPRINGFIELD, IL 62704
(217) 544-8118
(217) 544-8008
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
198000025
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8482034
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/26/2006
Last updated
12/08/2020
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