Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | 038.013027 | IL |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 038.013027 | IL |
NPI | 1811430481 |
---|---|
Provider Name | Dr. Mateusz Jan Cichowicz |
First Address | Hickory Hills, IL 60457-1012 |
Second Address | Hickory Hills, IL 60457-1012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2016 |
Last Update Date | 29/11/2016 |