Provider Demographics
NPI:1699315259
Name:KUCZO, ERICK
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:KUCZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-5310
Mailing Address - Country:US
Mailing Address - Phone:203-426-2490
Mailing Address - Fax:
Practice Address - Street 1:220 MAIN ST S STE 206
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2275
Practice Address - Country:US
Practice Address - Phone:203-586-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor