Provider Demographics
NPI:1437142023
Name:PELKOWSKI, RICHARD MARTIN (DC DM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MARTIN
Last Name:PELKOWSKI
Suffix:
Gender:M
Credentials:DC DM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:GREENTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44630-0337
Mailing Address - Country:US
Mailing Address - Phone:330-499-7020
Mailing Address - Fax:330-499-1120
Practice Address - Street 1:9700 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:OH
Practice Address - Zip Code:44630-0337
Practice Address - Country:US
Practice Address - Phone:330-499-7020
Practice Address - Fax:330-499-1120
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0155933Medicaid
T46280Medicare UPIN