Provider Demographics
NPI:1598298812
Name:DRZEWIECKI, CRYSTAL (DC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:DRZEWIECKI
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 1:1954 WALLING CT
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-3077
Mailing Address - Country:US
Mailing Address - Phone:920-217-8284
Mailing Address - Fax:
Practice Address - Street 1:1954 WALLING CT
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-3077
Practice Address - Country:US
Practice Address - Phone:920-217-8284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor