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General NPI Number Information
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NPI Number | 1821403429
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Entity Type | Individual
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Provider Name | JASON ROBERT BORECKI LMT
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Gender | Male
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Dates
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Enumeration Date | 06/23/2014
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 1811 W NORTH AVE STE 202
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City | CHICAGO
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State | IL
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Zip | 60622-1488
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Country | US
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Telephone | 312-656-1979
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 N STATE PKWY APT 907
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City | CHICAGO
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State | IL
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Zip | 60610-8112
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Country | US
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Telephone | 312-656-1979
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227000122
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License Number State | IL
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