Provider Demographics
NPI:1205050259
Name:GRZESIAKOWSKI, CARYN ANN (DC)
Entity type:Individual
Prefix:DR
First Name:CARYN
Middle Name:ANN
Last Name:GRZESIAKOWSKI
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:PO BOX 1378
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214
Mailing Address - Country:US
Mailing Address - Phone:770-478-6040
Mailing Address - Fax:770-478-6061
Practice Address - Street 1:809 FLINT RIVER ROAD
Practice Address - Street 2:SUITE #4
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238
Practice Address - Country:US
Practice Address - Phone:770-478-6040
Practice Address - Fax:770-478-6061
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006958111N00000X
FLCH8589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGNQMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER
GRP4208Medicare ID - Type UnspecifiedGROUP NUMBER
U87293Medicare UPIN