Provider Demographics
NPI:1528164340
Name:SIERADZKI, STEPHEN W (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:W
Last Name:SIERADZKI
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 1:2296 HENRY CLOWER BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3147
Mailing Address - Country:US
Mailing Address - Phone:770-982-5155
Mailing Address - Fax:770-982-4262
Practice Address - Street 1:2296 HENRY CLOWER BLVD STE B
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3147
Practice Address - Country:US
Practice Address - Phone:770-982-5155
Practice Address - Fax:770-982-4262
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHFFMedicare ID - Type Unspecified
GAT97837Medicare UPIN