Provider Demographics
NPI:1922030006
Name:DMOCHOWSKI, JOHN EDWARDS (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARDS
Last Name:DMOCHOWSKI
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:PO BOX 1178
Mailing Address - Street 2:
Mailing Address - City:CHALLIS
Mailing Address - State:ID
Mailing Address - Zip Code:83226
Mailing Address - Country:US
Mailing Address - Phone:208-879-2550
Mailing Address - Fax:208-879-3213
Practice Address - Street 1:1148 12TH ST
Practice Address - Street 2:
Practice Address - City:CHALLIS
Practice Address - State:ID
Practice Address - Zip Code:83226
Practice Address - Country:US
Practice Address - Phone:208-879-2550
Practice Address - Fax:208-879-3213
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T98156Medicare UPIN
1672441Medicare ID - Type UnspecifiedINDIVIDUAL #
1673919Medicare ID - Type UnspecifiedGROUP #