Provider Demographics
NPI:1215189949
Name:CZACH, JESSE ROYCE (DN)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:ROYCE
Last Name:CZACH
Suffix:
Gender:M
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 W COLONIAL PKWY
Mailing Address - Street 2:STE. 107
Mailing Address - City:INVERNESS
Mailing Address - State:IL
Mailing Address - Zip Code:60067-4755
Mailing Address - Country:US
Mailing Address - Phone:847-987-5249
Mailing Address - Fax:847-934-3368
Practice Address - Street 1:1608 W COLONIAL PKWY
Practice Address - Street 2:STE. 107
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60067-4755
Practice Address - Country:US
Practice Address - Phone:847-987-5249
Practice Address - Fax:847-934-3368
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181000320172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath