Distasio, Louis Thomas

Distasio, Louis Thomas is an individual health care provider with primary practice located at 716 S 2Nd St. , Springfield IL 62704. He recently has only one registered license in Other Service Providers / Acupuncturist, which is considered as his primary health care specialty. Distasio, Louis Thomas can be contacted via phone (217) 544-8118.

Contact Information

Primary practice address
716 S 2Nd St. Springfield IL 62704
Phone: (217) 544-8118
Fax: (217) 544-8008
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Acupuncturist 171100000X 198000025 Illinois

Profile Details

NPI number 1629153085
LBN Legal business name Distasio, Louis Thomas
Credentials Licensed Acupuncturist (LAC)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 26th, 2006
Last updated Dec 8th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629153085 NPPES
Illinois Other 8482034 BLUE CROSS BLUE SHIELD

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