Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038.011326 | IL |
N | 111NN1001X | Nutrition | 038011326 | IL |
N | 111NR0400X | Rehabilitation Chiropractor | 038011326 | IL |
NPI | 1396986105 |
---|---|
Provider Name | Mrs. Gina M. Moskalik |
First Address | Cary, IL 60013-0453 |
Second Address | Cary, IL 60013-3205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2009 |
Last Update Date | 07/08/2019 |