Provider Demographics
NPI:1083703144
Name:KUJAWSKI, KEITH LEONARD (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:LEONARD
Last Name:KUJAWSKI
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 1:870 N VILLA NUEVA DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4522
Mailing Address - Country:US
Mailing Address - Phone:623-846-0085
Mailing Address - Fax:623-848-7535
Practice Address - Street 1:7342 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-3170
Practice Address - Country:US
Practice Address - Phone:623-846-0085
Practice Address - Fax:623-848-7535
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor