Provider Demographics
NPI:1356568190
Name:ROBERT M. GRECZANIK M.AC, L.AC,INC
Entity type:Organization
Organization Name:ROBERT M. GRECZANIK M.AC, L.AC,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GRECZANIK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:206-548-1522
Mailing Address - Street 1:2025 112TH AVE NE STE 301
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-2950
Mailing Address - Country:US
Mailing Address - Phone:206-548-1522
Mailing Address - Fax:425-454-7471
Practice Address - Street 1:2025 112TH AVE NE STE 301
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2950
Practice Address - Country:US
Practice Address - Phone:206-548-1522
Practice Address - Fax:425-454-7471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA343171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty