Healthcare Provider Details

I. General information

NPI: 1518933654
Provider Name (Legal Business Name): GREGORY A WOJCIECHOWSKI DC DA BCO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7668 N ROTHWELL RD
STILLMAN VALLEY IL
61084
US

IV. Provider business mailing address

7668 N ROTHWELL RD
STILLMAN VALLEY IL
61084
US

V. Phone/Fax

Practice location:
  • Phone: 815-645-2644
  • Fax: 815-645-2644
Mailing address:
  • Phone: 815-645-2644
  • Fax: 815-645-2644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number038-003665
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: