Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 038-003665 | IL |
NPI | 1518933654 |
---|---|
Provider Name | Mr. Gregory A Wojciechowski |
First Address | Stillman Valley, IL 61084 |
Second Address | Stillman Valley, IL 61084 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 15/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0007182008 | BCBS (01) | IL |
769853 | BOILERMAKER (01) | IL |