Provider Demographics
NPI:1710045216
Name:CHUDZIKIEWICZ, EDWARD PETER (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:PETER
Last Name:CHUDZIKIEWICZ
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 1:340 MAPLE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3200
Mailing Address - Country:US
Mailing Address - Phone:508-481-1133
Mailing Address - Fax:508-229-0609
Practice Address - Street 1:340 MAPLE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3200
Practice Address - Country:US
Practice Address - Phone:508-481-1133
Practice Address - Fax:508-229-0609
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35299OtherBC/BS PROVIDER #
MA307543OtherHARVARD PILGRIM PROV #
MA715854OtherTUFTS PROVIDER #
MAY35299Medicare PIN
MA715854OtherTUFTS PROVIDER #