Provider Demographics
NPI:1275593626
Name:ERIC N. POTOCKI
Entity Type:Organization
Organization Name:ERIC N. POTOCKI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:N
Authorized Official - Last Name:POTOCKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-310-0680
Mailing Address - Street 1:25W330 GENEVA RD
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2328
Mailing Address - Country:US
Mailing Address - Phone:630-310-0680
Mailing Address - Fax:
Practice Address - Street 1:25W330 GENEVA RD
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2328
Practice Address - Country:US
Practice Address - Phone:630-310-0680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0038010221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232646OtherBLUE CROSS BLUE SHIELD