Provider Demographics
NPI:1033479779
Name:CZAJKA, JESSE ADAM (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:ADAM
Last Name:CZAJKA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8912 BLAKENEY PROFESSIONAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6734
Mailing Address - Country:US
Mailing Address - Phone:704-544-5353
Mailing Address - Fax:
Practice Address - Street 1:201 S ESTES DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7001
Practice Address - Country:US
Practice Address - Phone:419-388-1253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-28
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12058111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCH199D387Medicare PIN