Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038011455 | IL |
N | 111NN0400X | Neurology | 038011455 | IL |
N | 111NN1001X | Nutrition | 038011455 | IL |
N | 111NR0200X | Radiology | 038011455 | IL |
N | 213ER0200X | Radiology | 038011455 | IL |
N | 111NR0400X | Rehabilitation Chiropractor | 038011455 | IL |
N | 111NS0005X | Chiropractic Sports Physician | 038011455 | IL |
N | 111NX0100X | Occupational Health | 038011455 | IL |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 038011455 | IL |
NPI | 1033421532 |
---|---|
Provider Name | Krysten Tatarek |
First Address | Chicago, IL 60647-4388 |
Second Address | Chicago, IL 60618-3277 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2010 |
Last Update Date | 25/07/2014 |