MEDICARE: MATTHEW R GAJKOWSKI D.C., D.A.C.R.B.

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
1	111N00000X	Chiropractor	1738	OH
2	111NR0400X	Rehabilitation Chiropractor	1738	OH
3	171100000X	Acupuncturist	10	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4698900001	OTHER		DMERC

General Provider Information

NPI Number	:	1972648525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW R GAJKOWSKI D.C., D.A.C.R.B.

Provider Business Mailing Address
First Line	:	1458 COPLEY ROAD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-2654
Country	:	US
Telephone Number	:	330-836-8661
Fax Number	:	330-836-8757

Provider Business Practice Location Address
First Line	:	1458 COPLEY ROAD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44685-2654
Country	:	US
Telephone Number	:	330-836-8661
Fax Number	:	330-836-8757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/21/2011

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