Provider Demographics
NPI:1649248451
Name:CZACHOWSKI, BRIAN KENNETH (MS, ATC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KENNETH
Last Name:CZACHOWSKI
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 LACY AVE
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-3114
Mailing Address - Country:US
Mailing Address - Phone:630-939-0141
Mailing Address - Fax:
Practice Address - Street 1:1999 S SPRINGINSGUTH RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-5489
Practice Address - Country:US
Practice Address - Phone:847-891-2255
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer