Provider Demographics
NPI:1881670065
Name:DREWICZ, MARK STEVEN
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:DREWICZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4018
Mailing Address - Country:US
Mailing Address - Phone:414-476-6300
Mailing Address - Fax:
Practice Address - Street 1:1467 S 108TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4018
Practice Address - Country:US
Practice Address - Phone:414-476-6300
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor