Provider Demographics
NPI:1164865127
Name:KISHYK, ALEXANDER JOHN (DC)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JOHN
Last Name:KISHYK
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 1:4 SYMMES CT
Mailing Address - Street 2:
Mailing Address - City:CRANBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08512-2808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 SYMMES CT
Practice Address - Street 2:
Practice Address - City:CRANBURY
Practice Address - State:NJ
Practice Address - Zip Code:08512-2808
Practice Address - Country:US
Practice Address - Phone:609-409-0122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00381300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor