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General NPI Number Information
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NPI Number | 1265621841
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Entity Type | Organization
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Legal Business Name | DR. BRIAN E. KICZEK
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 216 ANDERSON AVE REAR OFFICE
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City | FAIRVIEW
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State | NJ
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Zip | 07022-1468
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Country | US
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Telephone | 201-313-8880
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Fax |
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Provider Business Mailing Address
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Address Line | 216 ANDERSON AVE REAR OFFICE
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City | FAIRVIEW
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State | NJ
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Zip | 07022-1468
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Country | US
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Telephone | 201-313-8880
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. BRIAN E. KICZEK
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Credential | D.C.
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Telephone | 201-313-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | MC05870
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License Number State | NJ
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