Healthcare Provider Details

I. General information

NPI: 1568454338
Provider Name (Legal Business Name): STEPHEN A ZASADNY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10751 W 143RD ST
ORLAND PARK IL
60462-1900
US

IV. Provider business mailing address

10751 W 143RD ST
ORLAND PARK IL
60462-1900
US

V. Phone/Fax

Practice location:
  • Phone: 708-460-8688
  • Fax: 708-460-9272
Mailing address:
  • Phone: 708-460-8688
  • Fax: 708-460-9272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: