Provider Demographics
NPI:1407889710
Name:DR. EDWARD J. KRZYKWA, DC, PC
Entity Type:Organization
Organization Name:DR. EDWARD J. KRZYKWA, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRZYKWA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-966-2229
Mailing Address - Street 1:6654 OLD TURNPIKE ROAD, SUITE 1
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17883-0025
Mailing Address - Country:US
Mailing Address - Phone:570-966-2229
Mailing Address - Fax:570-966-4881
Practice Address - Street 1:6654 OLD TURNPIKE ROAD, SUITE 1
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:PA
Practice Address - Zip Code:17883-0025
Practice Address - Country:US
Practice Address - Phone:570-966-2229
Practice Address - Fax:570-966-4881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001719L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01443001OtherCAPITOL BLUE CROSS
PAKR042794OtherTHE MEDICARE NUMBER WITH
PA042794Medicare ID - Type Unspecified
PA01443001OtherCAPITOL BLUE CROSS