Provider Demographics
NPI:1629155981
Name:LENKEWICZ, DAVID JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSEPH
Last Name:LENKEWICZ
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 1:580 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-4330
Mailing Address - Country:US
Mailing Address - Phone:401-274-0404
Mailing Address - Fax:401-274-0044
Practice Address - Street 1:580 SMITH ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4330
Practice Address - Country:US
Practice Address - Phone:401-274-0404
Practice Address - Fax:401-274-0044
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDC-0179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI44-00008OtherUNITED HEALTH PLANS OF NE
RI35900-9108 (#001)OtherBC/BS OF RI PROVIDER #
RI400503OtherBC/BS OF RI BLUECHIP
RI400503OtherBC/BS OF RI BLUECHIP