Provider Demographics
NPI:1467847277
Name:PODWOJSKI KEELEN CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:PODWOJSKI KEELEN CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PODWOJSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-897-8022
Mailing Address - Street 1:1561 S NOVATO BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4114
Mailing Address - Country:US
Mailing Address - Phone:415-897-8022
Mailing Address - Fax:
Practice Address - Street 1:1561 S NOVATO BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4114
Practice Address - Country:US
Practice Address - Phone:415-897-8022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty