Provider Demographics
NPI:1972648525
Name:GAJKOWSKI, MATTHEW R (DC, DACRB)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:GAJKOWSKI
Suffix:
Gender:M
Credentials:DC, DACRB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1458 COPLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-2654
Mailing Address - Country:US
Mailing Address - Phone:330-836-8661
Mailing Address - Fax:330-836-8757
Practice Address - Street 1:1458 COPLEY ROAD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44685-2654
Practice Address - Country:US
Practice Address - Phone:330-836-8661
Practice Address - Fax:330-836-8757
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1738111N00000X, 111NR0400X
OH10171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0225509Medicaid
4698900001OtherDMERC
U27625Medicare UPIN
OH4698900001Medicare NSC
4698900001OtherDMERC
GA0876741Medicare PIN