=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023056611
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN A SIKORSKY DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2006
-----------------------------------------------------
Last Update Date | 03/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 TYLER CREEK PLAZA
-----------------------------------------------------
City | ELGIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-645-0464
-----------------------------------------------------
Fax | 847-695-0461
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 104 TYLER CREEK PLAZA
-----------------------------------------------------
City | ELGIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-645-0464
-----------------------------------------------------
Fax | 847-695-0461
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038008586
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------