Provider Demographics
NPI:1669461265
Name:JUSZCZYK, PAUL R (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:JUSZCZYK
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 1:849 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1306
Mailing Address - Country:US
Mailing Address - Phone:513-932-2955
Mailing Address - Fax:513-933-9417
Practice Address - Street 1:849 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1306
Practice Address - Country:US
Practice Address - Phone:513-932-2955
Practice Address - Fax:513-933-9417
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2546945Medicaid
OHU48655Medicare UPIN
OH2546945Medicaid