Healthcare Provider Details

I. General information

NPI: 1740602234
Provider Name (Legal Business Name): KONRAD GRZESZKOWIAK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 WAUKEGAN RD
GLENVIEW IL
60025-3077
US

IV. Provider business mailing address

10354 PARKSIDE AVE
OAK LAWN IL
60453-4562
US

V. Phone/Fax

Practice location:
  • Phone: 847-486-8000
  • Fax:
Mailing address:
  • Phone: 847-207-2407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012577
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: