Provider Demographics
NPI:1619381886
Name:JANKOWIAK, CHAD (RD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:JANKOWIAK
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3138 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9250
Mailing Address - Country:US
Mailing Address - Phone:989-280-7733
Mailing Address - Fax:
Practice Address - Street 1:3138 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9250
Practice Address - Country:US
Practice Address - Phone:989-280-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered