Provider Demographics
NPI:1437420767
Name:WOJSIAT, JERRY (DC)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:WOJSIAT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JAROSLAW
Other - Middle Name:
Other - Last Name:WOJSIAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:409 ALBERTO WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:409 ALBERTO WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-5407
Practice Address - Country:US
Practice Address - Phone:408-356-9459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0258250OtherMEDICARE