Provider Demographics
NPI:1548668304
Name:SKRZYNECKI, THADDEUS J III (DC)
Entity type:Individual
Prefix:
First Name:THADDEUS
Middle Name:J
Last Name:SKRZYNECKI
Suffix:III
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 1:4333 MONROE ST
Mailing Address - Street 2:STE D
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1937
Mailing Address - Country:US
Mailing Address - Phone:419-472-2610
Mailing Address - Fax:
Practice Address - Street 1:50 FOREST FALLS DR
Practice Address - Street 2:SUITE 4
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6937
Practice Address - Country:US
Practice Address - Phone:207-846-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2256111N00000X
OHDC-04649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty