Provider Demographics
NPI:1912918715
Name:KOCHANSKI, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KOCHANSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 ROOSEVELT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HILLSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60162-2074
Mailing Address - Country:US
Mailing Address - Phone:708-449-5900
Mailing Address - Fax:708-449-5901
Practice Address - Street 1:4413 ROOSEVELT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HILLSIDE
Practice Address - State:IL
Practice Address - Zip Code:60162-2074
Practice Address - Country:US
Practice Address - Phone:708-449-5900
Practice Address - Fax:708-449-5901
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
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
IL01634941OtherBCBS
IL4167137OtherCIGNA
ILU85409Medicare UPIN
IL210075Medicare ID - Type Unspecified