Provider Demographics
NPI:1194860148
Name:TOLODZIECKI, PETER G
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:G
Last Name:TOLODZIECKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 VETERANS HWY
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-2512
Mailing Address - Country:US
Mailing Address - Phone:215-781-1169
Mailing Address - Fax:215-788-8817
Practice Address - Street 1:1222 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-2512
Practice Address - Country:US
Practice Address - Phone:215-781-1169
Practice Address - Fax:215-788-8817
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007532-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor