Healthcare Provider Details

I. General information

NPI: 1497250302
Provider Name (Legal Business Name): JAN CHRISTOPHER SITKO ATC, LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2018
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W TOUHY AVE STE 202
CHICAGO IL
60646-1248
US

IV. Provider business mailing address

6000 W TOUHY AVE STE 202
CHICAGO IL
60646-1248
US

V. Phone/Fax

Practice location:
  • Phone: 773-774-4291
  • Fax: 773-774-4527
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number043.116227
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096.004640
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: