Provider Demographics
NPI:1114051208
Name:PROGRESSIVE MEDICINE, LTD.
Entity Type:Organization
Organization Name:PROGRESSIVE MEDICINE, LTD.
Other - Org Name:PARK AVENUE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENTPHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KARWOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-359-5483
Mailing Address - Street 1:110 W PARK AVE
Mailing Address - Street 2:STE. C
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-6201
Mailing Address - Country:US
Mailing Address - Phone:630-359-5483
Mailing Address - Fax:630-359-5624
Practice Address - Street 1:110 W PARK AVE
Practice Address - Street 2:STE. C
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-6201
Practice Address - Country:US
Practice Address - Phone:630-359-5483
Practice Address - Fax:630-359-5624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2012-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042618420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211452Medicare ID - Type Unspecified
ILV04670Medicare UPIN
ILK16560Medicare ID - Type UnspecifiedMEDICARE ID #