Healthcare Provider Details

I. General information

NPI: 1871238931
Provider Name (Legal Business Name): JACEK CZERWINSKI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10917 HIGHWAY 92 STE 160
WOODSTOCK GA
30188-6330
US

IV. Provider business mailing address

10917 HIGHWAY 92 STE 160
WOODSTOCK GA
30188-6330
US

V. Phone/Fax

Practice location:
  • Phone: 770-592-1915
  • Fax:
Mailing address:
  • Phone: 770-592-1915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC-05163
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR010908
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: