Healthcare Provider Details

I. General information

NPI: 1467771261
Provider Name (Legal Business Name): AMY NICOLE PRYCHITKO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S WELLS ST SUITE 150
CHICAGO IL
60607-4529
US

IV. Provider business mailing address

800 S WELLS ST SUITE 150
CHICAGO IL
60607-4529
US

V. Phone/Fax

Practice location:
  • Phone: 312-765-0411
  • Fax:
Mailing address:
  • Phone: 312-765-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011694
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: