Provider Demographics
NPI:1154314458
Name:CZEPIEL, THEODORE JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:JOHN
Last Name:CZEPIEL
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 1:448 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-2624
Mailing Address - Country:US
Mailing Address - Phone:413-732-0707
Mailing Address - Fax:413-746-9393
Practice Address - Street 1:448 ELM ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-2624
Practice Address - Country:US
Practice Address - Phone:413-732-0707
Practice Address - Fax:413-746-9393
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
44-04304OtherUNITED
60302OtherFIRST HEALTH
759281OtherTUFTS
0092323-002OtherCIGNA
11158146OtherCAQH
210189OtherACN
PVN2110353OtherAETNA
9063067OtherPHCS
210189OtherACN
44-04304OtherUNITED