Basic Information
Provider Information
NPI: 1003805656
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JARECKI
FirstName: STEVEN
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: D.C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2605 W ATLANTIC AVE
Address2: SUITE A101
City: DELRAY BEACH
State: FL
PostalCode: 334454413
CountryCode: US
TelephoneNumber: 5612668900
FaxNumber: 5612668900
Practice Location
Address1: 4811 W ATLANTIC AVE
Address2: #20
City: DELRAY BEACH
State: FL
PostalCode: 334453840
CountryCode: US
TelephoneNumber: 5614967106
FaxNumber: 5614967108
Other Information
ProviderEnumerationDate: 10/17/2005
LastUpdateDate: 06/01/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000XCH5678FLY Chiropractic ProvidersChiropractor 

No ID Information.


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