Individual
JACEK MIAZEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5848 N MASON AVE, CHICAGO, IL 60646-5408
(708) 539-1073
Mailing address
5848 N MASON AVE, CHICAGO, IL 60646-5408
(708) 539-1073
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227.009737
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
227.009737
PL2659711-BWI182175
IL
Enumeration date
09/01/2020
Last updated
09/01/2020
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