Individual
DEMETRIOS BOBOLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
512 W BURLINGTON AVE, SUITE 104, LA GRANGE, IL 60525-2221
(708) 469-7592
Mailing address
5757 N SHERIDAN RD, 17D, CHICAGO, IL 60660-4746
(773) 835-2626
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
198.001145
IL
Other
Enumeration date
05/01/2014
Last updated
05/01/2014
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