Provider Demographics
NPI:1528399359
Name:MIDCITY SPINE AND ORTHO REHABILITATION
Entity Type:Organization
Organization Name:MIDCITY SPINE AND ORTHO REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:DZIELAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-969-4777
Mailing Address - Street 1:4332 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-4009
Mailing Address - Country:US
Mailing Address - Phone:773-969-4777
Mailing Address - Fax:773-634-8295
Practice Address - Street 1:4332 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4009
Practice Address - Country:US
Practice Address - Phone:773-969-4777
Practice Address - Fax:773-634-8295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty