Provider Demographics
NPI:1063717676
Name:CYBULSKI, RANDAL R (DC)
Entity type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:R
Last Name:CYBULSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:RANDY
Other - Middle Name:R
Other - Last Name:CYBULSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:12337 S ROUTE 59
Mailing Address - Street 2:SUITE 119
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-4625
Mailing Address - Country:US
Mailing Address - Phone:815-267-6263
Mailing Address - Fax:815-782-8549
Practice Address - Street 1:12337 S ROUTE 59
Practice Address - Street 2:SUITE 119
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-4625
Practice Address - Country:US
Practice Address - Phone:815-267-6263
Practice Address - Fax:815-782-8549
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-011835111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor