Healthcare Provider Details

I. General information

NPI: 1922071679
Provider Name (Legal Business Name): JASON M MAJCHROWSKI A.T.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 SUMMIT DR
LOCKPORT IL
60441-3241
US

IV. Provider business mailing address

5 PHEASANT CT
WOODRIDGE IL
60517-1723
US

V. Phone/Fax

Practice location:
  • Phone: 815-834-9901
  • Fax: 815-834-9904
Mailing address:
  • Phone: 630-852-5093
  • 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: