Provider Demographics
NPI:1366427361
Name:WOJESKI, GARY LEE (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:WOJESKI
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 1:1100 HARDEE RD
Mailing Address - Street 2:STE 114
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-2529
Mailing Address - Country:US
Mailing Address - Phone:252-527-7704
Mailing Address - Fax:252-523-9919
Practice Address - Street 1:1100 HARDEE RD
Practice Address - Street 2:STE 114
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-2529
Practice Address - Country:US
Practice Address - Phone:252-527-7704
Practice Address - Fax:252-523-9919
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908937Medicaid
NC08937OtherBLUE CROSS/BLUE SHIELD
NC2447702Medicare ID - Type Unspecified
NCU37654Medicare UPIN