Organization
PROACTIVE NATURAL MEDICINE, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL MATTHEW MIKULSKI D.C., C.C.N. (PRESIDENT)
(773) 573-6348
Entity
Organization
Contact information
Practice address
5929 N MOBILE AVE, CHICAGO, IL 60646-5330
(773) 573-6348
Mailing address
5929 N MOBILE AVE, CHICAGO, IL 60646-5330
(773) 573-6348
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635895
BCBS
IL
Enumeration date
07/17/2006
Last updated
08/22/2020
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