Healthcare Provider Details

I. General information

NPI: 1013908029
Provider Name (Legal Business Name): PETER SZYNKOWICZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PENDLETON DRIVE
HEBRON CT
06248-0056
US

IV. Provider business mailing address

10 PENDLETON DRIVE PO BOX 56-
HEBRON CT
06248-0056
US

V. Phone/Fax

Practice location:
  • Phone: 860-228-1441
  • Fax: 860-228-1441
Mailing address:
  • Phone: 860-228-1441
  • Fax: 860-228-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number652
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: