Provider Demographics
NPI:1396986105
Name:MOSKALIK, GINA M (DC)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:M
Last Name:MOSKALIK
Suffix:
Gender:F
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:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-0453
Mailing Address - Country:US
Mailing Address - Phone:847-658-6066
Mailing Address - Fax:866-837-6099
Practice Address - Street 1:716 LAUREL LN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-3205
Practice Address - Country:US
Practice Address - Phone:847-658-6066
Practice Address - Fax:866-837-6099
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011326111NN1001X, 111NR0400X
IL038.011326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NR0400XChiropractic ProvidersChiropractorRehabilitation