Provider Demographics
NPI:1922846328
Name:GRODZICKI, LONDON TAYLOR (DC)
Entity type:Individual
Prefix:
First Name:LONDON
Middle Name:TAYLOR
Last Name:GRODZICKI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LONDON
Other - Middle Name:TAYLOR
Other - Last Name:MARDNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10910 STATE ROAD 70 E STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-8406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10910 STATE ROAD 70 E STE 101
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-8406
Practice Address - Country:US
Practice Address - Phone:941-799-7207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor