Provider Demographics
NPI:1679604490
Name:GRZANKOWSKI, EDWIN (DC)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:GRZANKOWSKI
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 1:3795 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1907
Mailing Address - Country:US
Mailing Address - Phone:716-837-1725
Mailing Address - Fax:716-837-2841
Practice Address - Street 1:3795 HARLEM RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1907
Practice Address - Country:US
Practice Address - Phone:716-837-1725
Practice Address - Fax:716-837-2841
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX001753-2111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12210AMedicare ID - Type Unspecified