Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | IL |
NPI | 1013011493 |
---|---|
Provider Name | Andrew Jerry Czarniewski |
First Address | Naperville, IL 60564 |
Second Address | Naperville, IL 60564 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0227561 | BCBS (01) | IL |
U85054 | (02) |