Individual
JOHN RICHARD JEZIORO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1565 FAIRMONT AVE, FAIRMONT, WV 26554-2158
(304) 363-8890
(304) 363-8902
Mailing address
1565 FAIRMONT AVE, FAIRMONT, WV 26554-2158
(304) 363-8890
(304) 363-8902
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
660
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000342746
BCBS
WV
05
—
7600047000
—
WV
Enumeration date
11/24/2006
Last updated
11/29/2011
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