Provider Demographics
NPI:1194943852
Name:ROZICH, RICHARD J (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:ROZICH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6305 W 95TH ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2255
Mailing Address - Country:US
Mailing Address - Phone:708-423-8280
Mailing Address - Fax:708-423-8295
Practice Address - Street 1:6305 W 95TH ST
Practice Address - Street 2:SUITE 310
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2255
Practice Address - Country:US
Practice Address - Phone:708-423-8280
Practice Address - Fax:708-423-8295
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01682624OtherBLUE CROSS BLUE SHIELD
IL731080Medicare ID - Type Unspecified