Provider Demographics
NPI:1386040681
Name:DRZEWIECKI, MICHAEL NATHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:NATHAN
Last Name:DRZEWIECKI
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 1:199 S ADDISON RD
Mailing Address - Street 2:#106
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-1929
Mailing Address - Country:US
Mailing Address - Phone:810-252-1804
Mailing Address - Fax:
Practice Address - Street 1:199 S ADDISON RD
Practice Address - Street 2:#106
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-1929
Practice Address - Country:US
Practice Address - Phone:810-252-1804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2016-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012992111NN0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111NS0005XChiropractic ProvidersChiropractorSports Physician