Healthcare Provider Details

I. General information

NPI: 1851128441
Provider Name (Legal Business Name): JACKIE KOTECKI DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 W INDIANA AVE
BEECHER IL
60401
US

IV. Provider business mailing address

466 W INDIANA AVE
BEECHER IL
60401
US

V. Phone/Fax

Practice location:
  • Phone: 219-232-9649
  • Fax: 219-349-0023
Mailing address:
  • Phone: 219-232-9649
  • Fax: 219-349-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08003472A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: