Provider Demographics
NPI:1225057268
Name:JOZWIAK, JENNIFER LYNN (LLC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:JOZWIAK
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 GLACIER HWY STE 120
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8565
Mailing Address - Country:US
Mailing Address - Phone:907-463-3051
Mailing Address - Fax:907-463-3171
Practice Address - Street 1:10301 GLACIER HWY STE 120
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8565
Practice Address - Country:US
Practice Address - Phone:907-463-3051
Practice Address - Fax:907-463-3171
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK166550OtherPTAN
AK1225415045OtherNPI
AK47-2650087OtherEIN