Provider Demographics
NPI:1669538104
Name:SUPERCZYNSKI, STEVEN E (DC, FICPA, DACCP)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:E
Last Name:SUPERCZYNSKI
Suffix:
Gender:M
Credentials:DC, FICPA, DACCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S WASHINGTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6656
Mailing Address - Country:US
Mailing Address - Phone:630-355-4450
Mailing Address - Fax:630-355-4950
Practice Address - Street 1:600 S WASHINGTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6666
Practice Address - Country:US
Practice Address - Phone:630-355-4450
Practice Address - Fax:630-355-4950
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232310OtherBCBS OF IL
IL206676Medicare ID - Type Unspecified