Provider Demographics
NPI:1477540730
Name:MIERZEJEWSKI, ERIC RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:RICHARD
Last Name:MIERZEJEWSKI
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 1:11721 JEFFERSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1935
Mailing Address - Country:US
Mailing Address - Phone:757-224-9223
Mailing Address - Fax:757-224-9293
Practice Address - Street 1:11721 JEFFERSON AVE STE 101
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1935
Practice Address - Country:US
Practice Address - Phone:757-224-9223
Practice Address - Fax:757-224-9293
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U99608Medicare UPIN
SCAA03907947Medicare ID - Type Unspecified