Provider Demographics
NPI:1306149661
Name:DUTKA CHIROPRACTIC, S.C.
Entity type:Organization
Organization Name:DUTKA CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:C
Authorized Official - Last Name:DUTKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-439-9300
Mailing Address - Street 1:657 E GOLF RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4071
Mailing Address - Country:US
Mailing Address - Phone:847-439-9300
Mailing Address - Fax:847-439-9301
Practice Address - Street 1:657 E GOLF RD
Practice Address - Street 2:SUITE 301
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4071
Practice Address - Country:US
Practice Address - Phone:847-439-9300
Practice Address - Fax:847-439-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty