Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038006811 | IL |
NPI | 1003823261 |
---|---|
Provider Name | James J Nabzdyk |
First Address | Plainfield, IL 60586-9060 |
Second Address | Plainfield, IL 60586-9060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 09/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
038006811 | LICENSE # (01) | IL |
09932409 | BC/BS PROVIDER # (01) | IL |
U33101 | (02) | IL |