Provider Demographics
NPI:1538267257
Name:PISCZEK, KRISTOPHER RYAN (DC)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:RYAN
Last Name:PISCZEK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2002
Mailing Address - Country:US
Mailing Address - Phone:740-376-9944
Mailing Address - Fax:740-376-0094
Practice Address - Street 1:325 4TH ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2002
Practice Address - Country:US
Practice Address - Phone:740-376-9944
Practice Address - Fax:740-376-0094
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV788111N00000X
OH3448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPI4128441Medicare PIN
OHU77505Medicare UPIN