Provider Demographics
NPI:1770293029
Name:KRAJESKI, WYATT T (LICENSED ACU)
Entity type:Individual
Prefix:
First Name:WYATT
Middle Name:T
Last Name:KRAJESKI
Suffix:
Gender:M
Credentials:LICENSED ACU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 PROSPECTOR AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7510
Mailing Address - Country:US
Mailing Address - Phone:453-655-1578
Mailing Address - Fax:
Practice Address - Street 1:1816 PROSPECTOR AVE STE 202
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7510
Practice Address - Country:US
Practice Address - Phone:453-655-1578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6684460-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist