Provider Demographics
NPI:1679768741
Name:NOONAN, JAMES P
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:NOONAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14340 S LA GRANGE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2517
Mailing Address - Country:US
Mailing Address - Phone:708-349-4580
Mailing Address - Fax:708-349-4052
Practice Address - Street 1:14340 S LA GRANGE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2517
Practice Address - Country:US
Practice Address - Phone:708-349-4580
Practice Address - Fax:708-349-4052
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1682615OtherBLUE CROSS BLUE SHIELD
IL1682615OtherBLUE CROSS BLUE SHIELD