Provider Demographics
NPI:1093734881
Name:JURIK, ANNA (DC, RD, LDN)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:JURIK
Suffix:
Gender:F
Credentials:DC, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E OGDEN AVE
Mailing Address - Street 2:SUITE #202
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3542
Mailing Address - Country:US
Mailing Address - Phone:630-655-9480
Mailing Address - Fax:630-655-9490
Practice Address - Street 1:120 E OGDEN AVE
Practice Address - Street 2:SUITE #202
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3542
Practice Address - Country:US
Practice Address - Phone:630-655-9480
Practice Address - Fax:630-655-9490
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010439111N00000X
IL164003250133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV07696Medicare UPIN
IL212746Medicare PIN