Provider Demographics
NPI:1366557225
Name:KLESTINSKI, MATTHEW L (D C)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:L
Last Name:KLESTINSKI
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 S MILWAUKEE AVENUE FORUM SQUARE BLDG B STE 2
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048
Mailing Address - Country:US
Mailing Address - Phone:847-204-6998
Mailing Address - Fax:
Practice Address - Street 1:1117 S MILWAUKEE AVENUE FORUM SQUARE BLDG B STE 2
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048
Practice Address - Country:US
Practice Address - Phone:847-204-6998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010213111N00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No111N00000XChiropractic ProvidersChiropractor