| Doctor Name: | VIDA PUODZIUNAS |
| NPI Number: | 1528064110 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.C. |
| License Number: | 038009499 |
| Business Practice Address: | 16626 W 159th St Suite 700 Lockport, IL - 604418018 |
| Business Phone Number: | 8158349075 |
| Business Fax Number: | 8158349077 |
| Mailing Address: | 16626 W 159th St, Suite 700 LOCKPORT |
| State: | IL |
| Postal Code: | 604418018 |
| Phone Number: | 8158349075 |
| Fax Number: | 8158349077 |
| NPI Enumeration Date: | 06/28/2005 |
| NPI Last Update Date: | 04/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 03/17/2006 |
| NPI Reactivation Date: | 03/24/2006 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 111N00000X |
| License Number: | 038009499 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Chiropractic Providers |
| Taxonomy Classification: | Chiropractor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |