Provider Demographics
NPI:1952445173
Name:IWASECZKO, TATIANA (DC)
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:
Last Name:IWASECZKO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 HERITAGE AVE
Mailing Address - Street 2:#15
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5662
Mailing Address - Country:US
Mailing Address - Phone:603-436-9009
Mailing Address - Fax:603-436-9069
Practice Address - Street 1:70 HERITAGE AVE
Practice Address - Street 2:#15
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5662
Practice Address - Country:US
Practice Address - Phone:603-436-9009
Practice Address - Fax:603-436-9069
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH#570-0999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30250570Medicaid
NH9771046Medicare UPIN
NH30250570Medicaid
NHRE5567Medicare ID - Type Unspecified