Healthcare Provider Details

I. General information

NPI: 1023411287
Provider Name (Legal Business Name): SUSANNE KOWALSKI D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 N PARIS AVE
CHICAGO IL
60656-1550
US

IV. Provider business mailing address

5500 N PARIS AVE
CHICAGO IL
60656-1550
US

V. Phone/Fax

Practice location:
  • Phone: 773-636-6951
  • Fax:
Mailing address:
  • Phone: 773-636-6951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.012671
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: