Provider Demographics
NPI:1174719652
Name:LIZEWSKI, KELLY A (KELLY LIZEWSKI DC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:A
Last Name:LIZEWSKI
Suffix:
Gender:F
Credentials:KELLY LIZEWSKI DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WESTON ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTN STA
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4031
Mailing Address - Country:US
Mailing Address - Phone:516-410-5469
Mailing Address - Fax:631-423-7316
Practice Address - Street 1:6 WESTON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTN STA
Practice Address - State:NY
Practice Address - Zip Code:11746-4031
Practice Address - Country:US
Practice Address - Phone:516-410-5469
Practice Address - Fax:631-423-7316
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0107471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor