Provider Demographics
NPI:1518933654
Name:WOJCIECHOWSKI, GREGORY A (DC DA BCO)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:A
Last Name:WOJCIECHOWSKI
Suffix:
Gender:M
Credentials:DC DA BCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7668 N ROTHWELL RD
Mailing Address - Street 2:
Mailing Address - City:STILLMAN VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61084
Mailing Address - Country:US
Mailing Address - Phone:815-645-2644
Mailing Address - Fax:815-645-2644
Practice Address - Street 1:7668 N ROTHWELL RD
Practice Address - Street 2:
Practice Address - City:STILLMAN VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61084
Practice Address - Country:US
Practice Address - Phone:815-645-2644
Practice Address - Fax:815-645-2644
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-003665111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL769853OtherBOILERMAKER
IL0007182008OtherBCBS
IL234490Medicare ID - Type Unspecified