Provider Demographics
NPI:1588756225
Name:MICHALOWSKI, GARY EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:EDWARD
Last Name:MICHALOWSKI
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 1:201 STEPHEN ST
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-3710
Mailing Address - Country:US
Mailing Address - Phone:630-257-9132
Mailing Address - Fax:630-257-9136
Practice Address - Street 1:201 STEPHEN ST
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-3710
Practice Address - Country:US
Practice Address - Phone:630-257-9132
Practice Address - Fax:630-257-9136
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-005266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1682603OtherBLUE CROSS BLUE SHIELD
IL36-3629679OtherTIN
IL36-3629679OtherTIN