Provider Demographics
NPI:1457480519
Name:RECZEK, KANE PHILIP (DC)
Entity Type:Individual
Prefix:DR
First Name:KANE
Middle Name:PHILIP
Last Name:RECZEK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 GRANDIN RD SW
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-2815
Mailing Address - Country:US
Mailing Address - Phone:540-521-9880
Mailing Address - Fax:
Practice Address - Street 1:1701 GRANDIN RD SW
Practice Address - Street 2:SUITE 7
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-2815
Practice Address - Country:US
Practice Address - Phone:540-521-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor