Provider Demographics
NPI:1629272471
Name:MARUSZAK, JOANN LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:LYNN
Last Name:MARUSZAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24041 S NAVAJO DR
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-3249
Mailing Address - Country:US
Mailing Address - Phone:815-467-0339
Mailing Address - Fax:
Practice Address - Street 1:524 W MONDAMIN ST
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-9394
Practice Address - Country:US
Practice Address - Phone:815-467-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03207464OtherBCBS
IL386790Medicare ID - Type Unspecified
IL03207464OtherBCBS