Healthcare Provider Details

I. General information

NPI: 1891071114
Provider Name (Legal Business Name): NOWICKI CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 HICKS RD SUITE C
ROLLING MEADOWS IL
60008-1250
US

IV. Provider business mailing address

1841 HICKS RD SUITE C
ROLLING MEADOWS IL
60008-1250
US

V. Phone/Fax

Practice location:
  • Phone: 847-845-4281
  • Fax: 847-496-5685
Mailing address:
  • Phone: 847-845-4281
  • Fax: 847-496-5685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number038010616
License Number StateIL

VIII. Authorized Official

Name: DR. NICHOLAS NOWICKI
Title or Position: OWNER
Credential: D.C.
Phone: 847-845-4281