Provider Demographics
NPI:1730192733
Name:FEDORCZYK, MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:FEDORCZYK
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 1:10020 SOUTHERN MARYLAND BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-3031
Mailing Address - Country:US
Mailing Address - Phone:410-286-3335
Mailing Address - Fax:410-286-0383
Practice Address - Street 1:10020 SOUTHERN MARYLAND BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-3031
Practice Address - Country:US
Practice Address - Phone:410-286-3335
Practice Address - Fax:410-286-0383
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor