Healthcare Provider Details

I. General information

NPI: 1275691743
Provider Name (Legal Business Name): RICHARD ALEXANDER CZAJKOWSKI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 WEST STEUBEN ST
BATH NY
14810
US

IV. Provider business mailing address

20 PARK DR
HORNELL NY
14843-2213
US

V. Phone/Fax

Practice location:
  • Phone: 607-776-5933
  • Fax: 607-776-0933
Mailing address:
  • Phone: 607-324-7246
  • Fax: 607-324-7249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX009057
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: