Healthcare Provider Details

I. General information

NPI: 1225442502
Provider Name (Legal Business Name): DOMINIKA MALINOWSKA HERTSBERG D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 W NORTH AVE
CHICAGO IL
60647-5369
US

IV. Provider business mailing address

2325 W NORTH AVE
CHICAGO IL
60647-5369
US

V. Phone/Fax

Practice location:
  • Phone: 312-880-9697
  • Fax: 773-337-9106
Mailing address:
  • Phone: 312-880-9697
  • Fax: 773-337-9106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.012628
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number038012628
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: