Provider Demographics
NPI:1548208358
Name:PRZYBYSZ, JEFFERY ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:ALLEN
Last Name:PRZYBYSZ
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 1:842 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1537
Mailing Address - Country:US
Mailing Address - Phone:440-871-4700
Mailing Address - Fax:440-871-4702
Practice Address - Street 1:36001 EUCLID AVE
Practice Address - Street 2:SUITE A-18
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4643
Practice Address - Country:US
Practice Address - Phone:440-942-1052
Practice Address - Fax:440-942-2288
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0513046Medicaid
OH350047128OtherMEDICARE RAILROAD PIN
OH0513046Medicaid
OH350047128OtherMEDICARE RAILROAD PIN