Healthcare Provider Details

I. General information

NPI: 1073596805
Provider Name (Legal Business Name): JOHN KARDYNALCZYK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2974 N LAKEWOOD CT
BLOOMINGTON IN
47408-1081
US

IV. Provider business mailing address

2974 N LAKEWOOD CT
BLOOMINGTON IN
47408-1081
US

V. Phone/Fax

Practice location:
  • Phone: 812-339-4430
  • Fax: 812-339-4476
Mailing address:
  • Phone: 812-339-4430
  • Fax: 812-339-4476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001673A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: