Provider Demographics
NPI:1568536738
Name:PODWOJSKI, PAUL DAVID (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:PODWOJSKI
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 1:208 VINTAGE WAY STE K25
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-5021
Mailing Address - Country:US
Mailing Address - Phone:415-897-8022
Mailing Address - Fax:415-897-8039
Practice Address - Street 1:208 VINTAGE WAY STE K25
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5021
Practice Address - Country:US
Practice Address - Phone:415-897-8022
Practice Address - Fax:415-897-8039
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor