Provider Demographics
NPI:1881721397
Name:KAWECKI, EDWARD S (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:S
Last Name:KAWECKI
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 1:2833 LINCOLN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-1924
Mailing Address - Country:US
Mailing Address - Phone:219-838-4880
Mailing Address - Fax:219-838-4880
Practice Address - Street 1:2833 LINCOLN ST
Practice Address - Street 2:SUITE A
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-1924
Practice Address - Country:US
Practice Address - Phone:219-838-4880
Practice Address - Fax:219-838-4880
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000966A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INT34982Medicare UPIN