Healthcare Provider Details

I. General information

NPI: 1760405971
Provider Name (Legal Business Name): KENNETH EDWARD WOJCIK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 BERT KOUNS INDUSTRIAL LOOP
SHREVEPORT LA
71118-5701
US

IV. Provider business mailing address

672 BERT KOUNS INDUSTRIAL LOOP
SHREVEPORT LA
71118-5701
US

V. Phone/Fax

Practice location:
  • Phone: 318-686-3152
  • Fax: 318-688-5846
Mailing address:
  • Phone: 318-686-3152
  • Fax: 318-688-5846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number402
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: