Individual
JERRY CLAUDE VONDRUSKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S.,ATC
Contact information
Practice address
153 S CIRCLE AVE, BLOOMINGDALE, IL 60108-1620
(630) 307-3651
Mailing address
153 S CIRCLE AVE, BLOOMINGDALE, IL 60108-1620
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
96000470
IL
Other
Enumeration date
03/09/2007
Last updated
07/08/2007
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