=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265561401
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DREW D KYCYNKA DC PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 09/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3091 ANDERSON SNOW RD
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34609-5202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-799-7753
-----------------------------------------------------
Fax | 352-799-7709
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3091 ANDERSON SNOW RD
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34609-5202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-799-7753
-----------------------------------------------------
Fax | 352-799-7709
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DREW DAVID KYCYNKA
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 352-683-7735
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHO6488
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------