Healthcare Provider Details

I. General information

NPI: 1588861330
Provider Name (Legal Business Name): KRISTIN DRZEWIECKI DEEUGENIO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/11/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 MONTAGE MOUNTAIN ROAD SUITE 3
MOOSIC PA
18507
US

IV. Provider business mailing address

73 MONTAGE MOUNTAIN ROAD SUITE 3
MOOSIC PA
18507
US

V. Phone/Fax

Practice location:
  • Phone: 570-800-7991
  • Fax:
Mailing address:
  • Phone: 570-800-7991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC009804
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00687100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: