Provider Demographics
NPI:1336417898
Name:POTRYKUS, JON ANTHONY (DIPL,AC)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:ANTHONY
Last Name:POTRYKUS
Suffix:
Gender:M
Credentials:DIPL,AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 N MORSON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3456
Mailing Address - Country:US
Mailing Address - Phone:989-249-9965
Mailing Address - Fax:989-249-9945
Practice Address - Street 1:2110 N MORSON ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3456
Practice Address - Country:US
Practice Address - Phone:989-249-9965
Practice Address - Fax:989-249-9945
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3360NCCAOM171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist