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General NPI Number Information
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NPI Number | 1740729474
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Entity Type | Organization
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Legal Business Name | JD MANIKOWSKI, D.D.S., LLC
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Dates
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Enumeration Date | 02/14/2017
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 30 N. MICHIGAN AVE #1520
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City | CHICAGO
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State | IL
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Zip | 60602
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Country | US
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Telephone | 312-236-9325
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Fax | 312-236-2901
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Provider Business Mailing Address
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Address Line | 1701 N. SHEFFIELD AVE
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City | CHICAGO
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State | IL
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Zip | 60614
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Country | US
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Telephone | 312-337-1665
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Fax | 312-337-1675
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK JOHN MANIKOWSKI
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Credential |
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Telephone | 312-236-9325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 019.024233
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License Number State | IL
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