Provider Demographics
NPI:1588774855
Name:KWAPISZESKI, SCOTT LEO (D C)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:LEO
Last Name:KWAPISZESKI
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 1:135 N ROY HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:GOODMAN
Mailing Address - State:MO
Mailing Address - Zip Code:64843-9806
Mailing Address - Country:US
Mailing Address - Phone:417-364-4060
Mailing Address - Fax:
Practice Address - Street 1:135 N ROY HILL BLVD
Practice Address - Street 2:
Practice Address - City:GOODMAN
Practice Address - State:MO
Practice Address - Zip Code:64843-9806
Practice Address - Country:US
Practice Address - Phone:417-364-4060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U55402OtherUPIN