Provider Demographics
NPI:1295711190
Name:DAWIDOWICZ, JOHN V (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:V
Last Name:DAWIDOWICZ
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 1:1770 SKYLYN DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1032
Mailing Address - Country:US
Mailing Address - Phone:864-583-8308
Mailing Address - Fax:864-583-8358
Practice Address - Street 1:1770 SKYLYN DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1045
Practice Address - Country:US
Practice Address - Phone:864-583-8308
Practice Address - Fax:864-583-8358
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH324Medicaid
SCCH2495Medicaid
SCCH2495Medicaid
SCGCH324Medicaid