Provider Demographics
NPI:1073596805
Name:KARDYNALCZYK, JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:KARDYNALCZYK
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 1:2974 N LAKEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-1081
Mailing Address - Country:US
Mailing Address - Phone:812-339-4430
Mailing Address - Fax:812-339-4476
Practice Address - Street 1:2974 N LAKEWOOD CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-1081
Practice Address - Country:US
Practice Address - Phone:812-339-4430
Practice Address - Fax:812-339-4476
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001673A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN352013880AOtherSIHO
IN000000186894OtherANTHEM BC/BS PROVIDER #
IN200166940AMedicaid
IN35201388001OtherSAGAMORE PROVIDER#
IN352013880AOtherSIHO
GAP00204813Medicare PIN