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General NPI Number Information
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NPI Number | 1902072903
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Entity Type | Individual
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Provider Name | JACIE J KUCHAN P.T. D.P.T.
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Gender | Female
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 11/03/2008
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Provider Practice Location Address
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Address Line | 233 E ERIE ST SUITE 404
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City | CHICAGO
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State | IL
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Zip | 60611-2926
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Country | US
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Telephone | 312-274-1100
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Fax | 312-274-1103
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Provider Business Mailing Address
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Address Line | 233 E ERIE ST SUITE 404
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City | CHICAGO
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State | IL
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Zip | 60611-2926
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Country | US
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Telephone | 312-274-1100
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Fax | 312-274-1103
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 070009635
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License Number State | IL
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