Healthcare Provider Details

I. General information

NPI: 1942284070
Provider Name (Legal Business Name): JOEL SUCHECKI A.T.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15400 127TH ST SUITE C
LEMONT IL
60439-8408
US

IV. Provider business mailing address

5728 PLYMOUTH ST
DOWNERS GROVE IL
60516-1229
US

V. Phone/Fax

Practice location:
  • Phone: 630-257-9787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: