Provider Demographics
NPI:1629178827
Name:KYCYNKA, DREW DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:DAVID
Last Name:KYCYNKA
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 1:3091 ANDERSON SNOW RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5202
Mailing Address - Country:US
Mailing Address - Phone:352-799-7753
Mailing Address - Fax:352-799-7709
Practice Address - Street 1:3091 ANDERSON SNOW RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5202
Practice Address - Country:US
Practice Address - Phone:352-799-7753
Practice Address - Fax:352-799-7709
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 6488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU44833Medicare UPIN