Provider Demographics
NPI:1104394824
Name:ZAJACKOWSKI, LYDIA ALICE (DC)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ALICE
Last Name:ZAJACKOWSKI
Suffix:
Gender:F
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:PO BOX #559
Mailing Address - Street 2:
Mailing Address - City:DRYDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98821
Mailing Address - Country:US
Mailing Address - Phone:360-319-2558
Mailing Address - Fax:
Practice Address - Street 1:1500 ALPENSEE STRASSE
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826
Practice Address - Country:US
Practice Address - Phone:509-548-5727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAC609640111N00000X
TX14089111N00000X
WACH60908640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor