Provider Demographics
NPI:1124388996
Name:KIM WOJCIK DC LLC
Entity Type:Organization
Organization Name:KIM WOJCIK DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WOJCIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-208-1582
Mailing Address - Street 1:77 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08501-1609
Mailing Address - Country:US
Mailing Address - Phone:609-208-1582
Mailing Address - Fax:609-259-5658
Practice Address - Street 1:77 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08501-1609
Practice Address - Country:US
Practice Address - Phone:609-208-1582
Practice Address - Fax:609-259-5658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00422400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJWO740668OtherMEDICARE