=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144632464
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TCP OF OSWEGO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2014
-----------------------------------------------------
Last Update Date | 05/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1935 95TH ST UNIT 115
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60564-9684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-781-9511
-----------------------------------------------------
Fax | 630-718-9868
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1935 95TH ST UNIT 115
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60564-9684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-781-9511
-----------------------------------------------------
Fax | 630-718-9868
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | DR. ANDREW CZARNIEWSKI
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 630-781-9511
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------