Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 038008999 | IL |
NPI | 1225300510 |
---|---|
Provider Name | Kevin Kulczyski |
First Address | Chicago, IL 60612-3531 |
Second Address | Chicago, IL 60612-3531 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2012 |
Last Update Date | 01/02/2012 |