Provider Demographics
NPI:1447335823
Name:WALCZYK, JEFFREY M (STUDENT INTERN)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:WALCZYK
Suffix:
Gender:M
Credentials:STUDENT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 TUNXIS HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825
Mailing Address - Country:US
Mailing Address - Phone:203-333-7788
Mailing Address - Fax:203-366-7566
Practice Address - Street 1:527 TUNXIS HILL ROAD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825
Practice Address - Country:US
Practice Address - Phone:203-333-7788
Practice Address - Fax:203-366-7566
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001716111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic