Provider Demographics
NPI:1114042454
Name:GORSKI, ANDREW R (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:R
Last Name:GORSKI
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 1:2 S 517 STATE ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-1254
Mailing Address - Country:US
Mailing Address - Phone:630-393-6699
Mailing Address - Fax:630-393-6760
Practice Address - Street 1:2S517 STATE ROUTE 59
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-1254
Practice Address - Country:US
Practice Address - Phone:630-393-6699
Practice Address - Fax:630-393-6760
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38-005745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02290031OtherBCBS
IL761490Medicare ID - Type Unspecified