Healthcare Provider Details

I. General information

NPI: 1316233364
Provider Name (Legal Business Name): COMPREHENSIVE SPINE & BODY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 W. IRVING PARK ROAD
CHICAGO IL
60641
US

IV. Provider business mailing address

4210 W. IRVING PARK ROAD
CHICAGO IL
60641
US

V. Phone/Fax

Practice location:
  • Phone: 312-493-7744
  • Fax: 773-777-7055
Mailing address:
  • Phone: 312-493-7744
  • Fax: 773-777-7055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number181.000366
License Number StateIL

VIII. Authorized Official

Name: DR. DOMINIKA ANDZELICA PIOTROWSKA
Title or Position: PRESIDENT
Credential: D.N.
Phone: 312-493-7744