Provider Demographics
NPI:1437255767
Name:CZARNIEWSKI, KELLY SHEEHAN (DC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:SHEEHAN
Last Name:CZARNIEWSKI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:SHEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1935 95TH STREET
Mailing Address - Street 2:SUITE 115
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564
Mailing Address - Country:US
Mailing Address - Phone:630-718-0848
Mailing Address - Fax:630-718-9868
Practice Address - Street 1:1935 95TH STREET
Practice Address - Street 2:SUITE 115
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564
Practice Address - Country:US
Practice Address - Phone:630-718-0848
Practice Address - Fax:630-718-9868
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02227561OtherBCBS
IL02227561OtherBCBS
U85053Medicare UPIN