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General NPI Number Information
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NPI Number | 1215189949
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Entity Type | Individual
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Provider Name | JESSE ROYCE CZACH D.N.
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Gender | Male
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Dates
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Enumeration Date | 10/13/2008
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Last Update Date | 10/30/2016
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Provider Practice Location Address
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Address Line | 1608 W COLONIAL PKWY STE. 107
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City | INVERNESS
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State | IL
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Zip | 60067-4755
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Country | US
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Telephone | 847-987-5249
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Fax | 847-934-3368
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Provider Business Mailing Address
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Address Line | 1608 W COLONIAL PKWY STE. 107
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City | INVERNESS
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State | IL
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Zip | 60067-4755
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Country | US
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Telephone | 847-987-5249
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Fax | 847-934-3368
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172P00000X
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Taxonomy Name | Naprapath
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License Number | 181000320
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License Number State | IL
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