Healthcare Provider Details

I. General information

NPI: 1154314458
Provider Name (Legal Business Name): THEODORE JOHN CZEPIEL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 ELM ST
WEST SPRINGFIELD MA
01089-2624
US

IV. Provider business mailing address

448 ELM ST
WEST SPRINGFIELD MA
01089-2624
US

V. Phone/Fax

Practice location:
  • Phone: 413-732-0707
  • Fax: 413-746-9393
Mailing address:
  • Phone: 413-732-0707
  • Fax: 413-746-9393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number704
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: