Provider Demographics
NPI:1528207636
Name:STEPHEN MAHALIK DC LTD
Entity Type:Organization
Organization Name:STEPHEN MAHALIK DC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHALIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC MD
Authorized Official - Phone:815-838-8545
Mailing Address - Street 1:515 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3032
Mailing Address - Country:US
Mailing Address - Phone:815-838-8545
Mailing Address - Fax:815-838-8548
Practice Address - Street 1:515 S STATE ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3032
Practice Address - Country:US
Practice Address - Phone:815-838-8545
Practice Address - Fax:815-838-8548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1356423966OtherTYPE 1 NPI