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NPI Code Detail

MEDICARE: DR. KELLY PAUL CZAJKOSKI D.C.

MEDICARE: DR. KELLY PAUL CZAJKOSKI D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor8240TX

General Provider Information

NPI Number : 1538163027
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY PAUL CZAJKOSKI D.C.
Provider Business Mailing Address
First Line : PO BOX 60
Second Line :
City : MARLIN
State : TX
Zip : 76661-0060
Country : US
Telephone Number : 254-803-3561
Fax Number : 254-883-6066
Provider Business Practice Location Address
First Line : 322 COLEMAN ST
Second Line :
City : MARLIN
State : TX
Zip : 76661-2358
Country : US
Telephone Number : 254-803-3561
Fax Number : 254-883-6066
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 07/08/2007

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