Provider Demographics
NPI:1407246515
Name:BONE AND JOINT CLINIC
Entity Type:Organization
Organization Name:BONE AND JOINT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DZIELAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-615-9446
Mailing Address - Street 1:4334 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5039
Mailing Address - Country:US
Mailing Address - Phone:773-615-9446
Mailing Address - Fax:
Practice Address - Street 1:4334 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5039
Practice Address - Country:US
Practice Address - Phone:773-615-9446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty