Individual
DR. JOSE ANTONIO CHACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5875 LANDERBROOK DR STE 250, MAYFIELD HTS, OH 44124-6502
(800) 487-4867
(216) 593-7533
Mailing address
125 E 13TH ST, # 1405, CHICAGO, IL 60605-2655
(312) 834-0521
(312) 834-0521
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
019-026092
IL
Other
Enumeration date
11/14/2006
Last updated
07/08/2007
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