Healthcare Provider Details

I. General information

NPI: 1760539704
Provider Name (Legal Business Name): KENNETH LOUIS GUZIK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W TEMPERANCE ST BOX 605
ELLETTSVILLE IN
47429
US

IV. Provider business mailing address

403 W TEMPERANCE ST BOX 605
ELLETTSVILLE IN
47429-1431
US

V. Phone/Fax

Practice location:
  • Phone: 812-876-6847
  • Fax: 812-876-8135
Mailing address:
  • Phone: 812-876-6847
  • Fax: 812-876-8135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08000775A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: