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Individual
MR. JACK CHODZEN
Active
Individual
MR. JACK CHODZEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01627212
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/09/2006
Last updated
01/02/2008
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