Provider Demographics
NPI:1588850218
Name:KWIATKOWSKI, JAYNE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JAYNE
Middle Name:MARIE
Last Name:KWIATKOWSKI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 PALM SPARROW CT
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1396
Mailing Address - Country:US
Mailing Address - Phone:202-365-8404
Mailing Address - Fax:
Practice Address - Street 1:225 N CAUSEWAY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-5239
Practice Address - Country:US
Practice Address - Phone:386-424-9977
Practice Address - Fax:386-423-3899
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382271100Medicaid
FLAH9457Medicare PIN