Provider Demographics
NPI:1346447414
Name:JUSZCZYK CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:JUSZCZYK CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:RAPHAEL
Authorized Official - Last Name:JUSZCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-932-2955
Mailing Address - Street 1:849 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1306
Mailing Address - Country:US
Mailing Address - Phone:513-932-2955
Mailing Address - Fax:
Practice Address - Street 1:849 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1306
Practice Address - Country:US
Practice Address - Phone:513-932-2955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-01
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2546945Medicaid
OH2546945Medicaid
OH9344551Medicare ID - Type UnspecifiedGROUP MEDICARE