Provider Demographics
NPI:1548301294
Name:JAKUBIEC, CYNTHIA LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LYNN
Last Name:JAKUBIEC
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:LYNN
Other - Last Name:EVANKOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:11524 183RD PL STE 200
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-9501
Mailing Address - Country:US
Mailing Address - Phone:708-462-5113
Mailing Address - Fax:
Practice Address - Street 1:11524 183RD PL STE 200
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-9501
Practice Address - Country:US
Practice Address - Phone:708-462-5113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
K14832Medicare ID - Type Unspecified
ILV03833Medicare UPIN