Provider Demographics
NPI:1194823757
Name:KAZMIERCZAK, PUJA WENTWORTH (DC)
Entity Type:Individual
Prefix:MRS
First Name:PUJA
Middle Name:WENTWORTH
Last Name:KAZMIERCZAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:PUJA
Other - Middle Name:ALLISON
Other - Last Name:WENTWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8300 BRASS MILL LN APT 107
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-8457
Mailing Address - Country:US
Mailing Address - Phone:207-680-0963
Mailing Address - Fax:919-463-0431
Practice Address - Street 1:148 MORRISVILLE SQUARE WAY
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-5703
Practice Address - Country:US
Practice Address - Phone:207-680-0963
Practice Address - Fax:919-463-0431
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1559111N00000X
NCNC3758111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor