Provider Demographics
NPI:1811067945
Name:JANCZAR, BOZENA GRAZYNA (DC)
Entity type:Individual
Prefix:
First Name:BOZENA
Middle Name:GRAZYNA
Last Name:JANCZAR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 N RIVERSIDE AVE
Mailing Address - Street 2:220
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-8071
Mailing Address - Country:US
Mailing Address - Phone:909-421-3003
Mailing Address - Fax:906-421-3092
Practice Address - Street 1:1850 N RIVERSIDE AVE
Practice Address - Street 2:220
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8071
Practice Address - Country:US
Practice Address - Phone:909-421-3003
Practice Address - Fax:906-421-3092
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0172050Medicare ID - Type Unspecified