Provider Demographics
NPI:1366975427
Name:GOLKIEWICZ, MICHAEL ANTHONY (D,C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:GOLKIEWICZ
Suffix:
Gender:M
Credentials:D,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 DARROW RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2623
Mailing Address - Country:US
Mailing Address - Phone:330-689-1234
Mailing Address - Fax:330-689-1235
Practice Address - Street 1:4015 DARROW RD
Practice Address - Street 2:SUITE A
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2623
Practice Address - Country:US
Practice Address - Phone:330-689-1234
Practice Address - Fax:330-689-1235
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor