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Organization
REVIVE CHIROPRACTIC
Active
Organization
REVIVE CHIROPRACTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WITOLD T GOZDALSKI (OWNER)
(773) 282-4300
Entity
Organization
Contact information
Practice address
6615 W IRVING PARK RD, STE. #301, CHICAGO, IL 60634-2410
(772) 282-4300
Mailing address
6615 W IRVING PARK RD, STE. #301, CHICAGO, IL 60634-2410
(772) 282-4300
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038-009590
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1633769
BCBS OF IL
IL
Enumeration date
12/29/2006
Last updated
08/01/2008
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