# TERESA A. WANCZYK

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275837734
- **Authorized official:** DR. TERESA A GROSVENOR M.S.,D.O. (PHYSICIAN)
- **Authorized official phone:** (773) 271-2900

## Contact information

- **Practice address:** 3420 W PETERSON AVE, SUITE 6, CHICAGO, IL 60659-3418
- **Practice address phone:** (773) 271-2900
- **Practice address fax:** (773) 267-6113
- **Mailing address:** 3420 W PETERSON AVE, SUITE 6, CHICAGO, IL 60659-3418
- **Mailing address phone:** (773) 271-2900
- **Mailing address fax:** (773) 267-6113

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | 036065883 | IL | Yes |

## Other

- **Enumeration date:** 12/27/2010
- **Last updated:** 01/05/2011