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General NPI Number Information
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NPI Number | 1861688699
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Entity Type | Organization
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Legal Business Name | MALKOWSKI CHIROPRACTIC PC
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Dates
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Enumeration Date | 09/14/2007
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Last Update Date | 12/23/2010
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Provider Practice Location Address
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Address Line | 1736 ESSINGTON RD SUITE C
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City | JOLIET
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State | IL
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Zip | 60435
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Country | US
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Telephone | 815-514-8513
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Fax |
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Provider Business Mailing Address
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Address Line | 550 SILVER LEAF DRIVE
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City | JOLIET
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State | IL
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Zip | 60431
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Country | US
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Telephone | 815-514-8513
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BECKY ROSS
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Credential | D.C.
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Telephone | 815-514-8513
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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 | 038.010966
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License Number State | IL
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