Provider Demographics
NPI:1225442502
Name:MALINOWSKA HERTSBERG, DOMINIKA (DC)
Entity Type:Individual
Prefix:
First Name:DOMINIKA
Middle Name:
Last Name:MALINOWSKA HERTSBERG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5369
Mailing Address - Country:US
Mailing Address - Phone:312-880-9697
Mailing Address - Fax:773-337-9106
Practice Address - Street 1:2325 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5369
Practice Address - Country:US
Practice Address - Phone:312-880-9697
Practice Address - Fax:773-337-9106
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012628111N00000X
IL038012628208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice