Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 001716 | CT |
NPI | 1447335823 |
---|---|
Provider Name | Dr. Jeffrey M Walczyk |
First Address | Fairfield, CT 06825 |
Second Address | Fairfield, CT 06825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 11/03/2020 |