Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038-008496 | IL |
NPI | 1013025824 |
---|---|
Provider Name | Dr. Darrin R Foszcz |
First Address | Spring Grove, IL 60081-9706 |
Second Address | Spring Grove, IL 60081-9706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 15/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0004932017 | BCBS PROVIDER # (01) | IL |
364478173 | TAX ID # (01) | IL |