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General NPI Number Information
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NPI Number | 1295954030
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Entity Type | Individual
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Provider Name | BRIAN EDWARD KICZEK D.C.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/28/2008
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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 | 201-313-8880
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Provider Business Mailing Address
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Address Line | 216 ANDERSON AV. REAR OFFICE
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City | FAIRVIEW
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State | NJ
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Zip | 07022
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Country | US
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Telephone | 201-313-8880
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Fax | 201-313-8880
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 38MC00587000
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License Number State | NJ
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