Provider Demographics
NPI:1669540340
Name:KAZMERSKI, J DONALD (DC)
Entity type:Individual
Prefix:DR
First Name:J DONALD
Middle Name:
Last Name:KAZMERSKI
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:KAZMERSKI CHIROPRACTIC 1100 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519
Mailing Address - Country:US
Mailing Address - Phone:570-489-9920
Mailing Address - Fax:
Practice Address - Street 1:KAZMERSKI CHIROPRACTIC 1100 MAIN ST
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519
Practice Address - Country:US
Practice Address - Phone:570-489-9920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004762L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000075782OtherUNISON
PA0012534110004Medicaid
KA688283Medicare ID - Type Unspecified
000000075782OtherUNISON