Provider Demographics
NPI:1871238931
Name:CZERWINSKI, JACEK (DC)
Entity type:Individual
Prefix:DR
First Name:JACEK
Middle Name:
Last Name:CZERWINSKI
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 1:10917 HIGHWAY 92 STE 160
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6330
Mailing Address - Country:US
Mailing Address - Phone:770-592-1915
Mailing Address - Fax:
Practice Address - Street 1:10917 HIGHWAY 92 STE 160
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6330
Practice Address - Country:US
Practice Address - Phone:770-592-1915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05163111NS0005X
GACHIR010908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician