Provider Demographics
NPI:1194999268
Name:KAREN R. DZEKUNSKAS
Entity type:Organization
Organization Name:KAREN R. DZEKUNSKAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DZEKUNSKAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-732-8606
Mailing Address - Street 1:1005 PEORIA STREET
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-2157
Mailing Address - Country:US
Mailing Address - Phone:217-732-8606
Mailing Address - Fax:217-735-1663
Practice Address - Street 1:1005 PEORIA STREET
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-2157
Practice Address - Country:US
Practice Address - Phone:217-732-8606
Practice Address - Fax:217-735-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006844111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05482010OtherBC/BS OF IL
IL038006844Medicaid
IL038006844Medicaid
IL05482010OtherBC/BS OF IL