Provider Demographics
NPI:1053383562
Name:BAKOURIS, JOHN L (ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:BAKOURIS
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8631 GLENSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-7041
Mailing Address - Country:US
Mailing Address - Phone:815-464-1294
Mailing Address - Fax:815-834-9904
Practice Address - Street 1:420 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3241
Practice Address - Country:US
Practice Address - Phone:815-834-9901
Practice Address - Fax:815-834-9904
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist