Healthcare Provider Details

I. General information

NPI: 1366427361
Provider Name (Legal Business Name): GARY LEE WOJESKI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 HARDEE RD STE 114
KINSTON NC
28504-2529
US

IV. Provider business mailing address

1100 HARDEE RD STE 114
KINSTON NC
28504-2529
US

V. Phone/Fax

Practice location:
  • Phone: 252-527-7704
  • Fax: 252-523-9919
Mailing address:
  • Phone: 252-527-7704
  • Fax: 252-523-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1861
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: