Provider Demographics
NPI:1063634202
Name:SUPERCZYNSKI FAMILY CHIROPRACTIC, LTD
Entity Type:Organization
Organization Name:SUPERCZYNSKI FAMILY CHIROPRACTIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SUPERCZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC,FICPA,DACCP
Authorized Official - Phone:630-355-4450
Mailing Address - Street 1:600 S WASHINGTON ST
Mailing Address - Street 2:SUITE200
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6666
Mailing Address - Country:US
Mailing Address - Phone:630-355-4450
Mailing Address - Fax:630-355-4950
Practice Address - Street 1:600 S WASHINGTON ST
Practice Address - Street 2:SUITE200
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6666
Practice Address - Country:US
Practice Address - Phone:630-355-4450
Practice Address - Fax:630-355-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Not Answered261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02233127OtherBCBS FOR CORP