Provider Demographics
NPI:1932267093
Name:MIECZKOWSKI, TIM EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:EDWARD
Last Name:MIECZKOWSKI
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 1:857 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:SAUK CENTRE
Mailing Address - State:MN
Mailing Address - Zip Code:56378-1646
Mailing Address - Country:US
Mailing Address - Phone:320-352-5227
Mailing Address - Fax:320-352-2865
Practice Address - Street 1:857 MAIN ST S
Practice Address - Street 2:
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378-1646
Practice Address - Country:US
Practice Address - Phone:320-352-5227
Practice Address - Fax:320-352-2865
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT65867Medicare UPIN