Individual
RYAN DEBOER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCDS, CEPS
Contact information
Practice address
2217 N SOUTHPORT AVE, CHICAGO, IL 60614-3114
(815) 245-3575
Mailing address
2217 N SOUTHPORT AVE, CHICAGO, IL 60614-3114
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
—
—
Other
Enumeration date
02/07/2018
Last updated
02/07/2018
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