Provider Demographics
NPI:1376683185
Name:DOBRZYNSKI, PETER JAMES
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JAMES
Last Name:DOBRZYNSKI
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 1:9003 MAIN ST
Mailing Address - Street 2:P.O. BOX 226
Mailing Address - City:MC KEAN
Mailing Address - State:PA
Mailing Address - Zip Code:16426-1432
Mailing Address - Country:US
Mailing Address - Phone:814-476-7828
Mailing Address - Fax:814-476-0002
Practice Address - Street 1:9003 MAIN ST
Practice Address - Street 2:
Practice Address - City:MC KEAN
Practice Address - State:PA
Practice Address - Zip Code:16426-1432
Practice Address - Country:US
Practice Address - Phone:814-476-7828
Practice Address - Fax:814-476-0002
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006263-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001532374001Medicaid
PADO788527Medicare ID - Type Unspecified