Basic Information
| Provider Information | |||||||||
| NPI: | 1427237999 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERNACKI | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1251 N PLUM GROVE RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | SCHAUMBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601735609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475191090 | ||||||||
| FaxNumber: | 8475190599 | ||||||||
| Practice Location | |||||||||
| Address1: | 714 E HIGGINS RD | ||||||||
| Address2: | |||||||||
| City: | SCHAUMBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601734701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475191090 | ||||||||
| FaxNumber: | 8475190599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2007 | ||||||||
| LastUpdateDate: | 01/18/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 038004453 | IL | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 21609942 | 01 | IL | BLUE CROSS | OTHER |