Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 038.012992 | IL |
N | 111NS0005X | Chiropractic Sports Physician | 038.012992 | IL |
NPI | 1386040681 |
---|---|
Provider Name | Dr. Michael Nathan Drzewiecki |
First Address | Wood Dale, IL 60191-1929 |
Second Address | Wood Dale, IL 60191-1929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2014 |
Last Update Date | 31/12/2016 |