Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 12058 | TX |
Y | 111NR0400X | Rehabilitation Chiropractor | 12058 | TX |
NPI | 1033479779 |
---|---|
Provider Name | Dr. Jesse Adam Czajka |
First Address | Charlotte, NC 28277-6734 |
Second Address | Chapel Hill, NC 27514-7001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2012 |
Last Update Date | 16/05/2014 |