Provider Demographics
NPI:1649238833
Name:SAKALOSKY, MARY ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ROSE
Last Name:SAKALOSKY
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 1:444 N HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-3508
Mailing Address - Country:US
Mailing Address - Phone:309-344-4030
Mailing Address - Fax:309-344-4032
Practice Address - Street 1:444 N HENDERSON ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-3508
Practice Address - Country:US
Practice Address - Phone:309-344-4030
Practice Address - Fax:309-344-4032
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04830278OtherBLUE CROSS PIN
ILDB3897Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP #
ILK08091Medicare PIN
IL04830278OtherBLUE CROSS PIN
IL209465Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER