MEDICARE: JEFFERY PHILLIP KONWINSKI D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	1086	OH

General Provider Information

NPI Number	:	1558871566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY PHILLIP KONWINSKI D.C.

Provider Business Mailing Address
First Line	:	1387 VIRGINIA AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-3040
Country	:	US
Telephone Number	:	614-670-5614
Fax Number	:	614-670-5614

Provider Business Practice Location Address
First Line	:	1217 GRANDVIEW AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-3455
Country	:	US
Telephone Number	:	614-670-5614
Fax Number	:	614-670-5614

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2017
Last Update Date	:	10/04/2017

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