Provider Demographics
NPI:1396709770
Name:RYBAK JR., GEORGE WALTER JR (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WALTER
Last Name:RYBAK JR.
Suffix:JR
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 1:1300 W TOUHY AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3102
Mailing Address - Country:US
Mailing Address - Phone:847-698-7777
Mailing Address - Fax:847-698-7713
Practice Address - Street 1:1300 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3102
Practice Address - Country:US
Practice Address - Phone:847-698-7777
Practice Address - Fax:847-698-7713
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV06123Medicare UPIN
ILK19965Medicare ID - Type UnspecifiedMEMBER #