Individual
DR. MICHAEL ANTHONY PONTARELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1811 W NORTH AVE, SUITE 202, CHICAGO, IL 60622-0202
(773) 235-7878
(773) 235-7894
Mailing address
620 N CARLYLE LN, ARLINGTON HTS, IL 60004-5751
(847) 754-1946
(773) 235-7894
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038009742
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1634086
BLUE CROSS BLUE SHIELD
IL
Enumeration date
11/27/2006
Last updated
10/29/2008
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