Provider Demographics
NPI:1952105702
Name:KADZIELA, DOMINIC DEVON (DC)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:DEVON
Last Name:KADZIELA
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 1:40 N NICE ST
Mailing Address - Street 2:
Mailing Address - City:FRACKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17931-1330
Mailing Address - Country:US
Mailing Address - Phone:570-391-6844
Mailing Address - Fax:
Practice Address - Street 1:246 S LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:FRACKVILLE
Practice Address - State:PA
Practice Address - Zip Code:17931-2205
Practice Address - Country:US
Practice Address - Phone:570-874-3002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC012032111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor