Provider Demographics
NPI:1821215591
Name:GRECZANIK, ROBERT MICHAEL (LAC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:GRECZANIK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 112TH AVE NE STE 301
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-2950
Mailing Address - Country:US
Mailing Address - Phone:425-454-7472
Mailing Address - Fax:424-454-7471
Practice Address - Street 1:2025 112TH AVE NE STE 301
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2950
Practice Address - Country:US
Practice Address - Phone:425-454-7472
Practice Address - Fax:424-454-7471
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA343171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist