Provider Demographics
NPI:1023151297
Name:KOLODZIEJ, LEON THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:THOMAS
Last Name:KOLODZIEJ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7742 W ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3018
Mailing Address - Country:US
Mailing Address - Phone:773-589-9996
Mailing Address - Fax:773-589-9998
Practice Address - Street 1:7742 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3018
Practice Address - Country:US
Practice Address - Phone:773-589-9996
Practice Address - Fax:773-589-9998
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL944560Medicare ID - Type Unspecified
IL13498Medicare UPIN