Provider Demographics
NPI:1336489582
Name:WYCKOFF, CLAES R (DC)
Entity Type:Individual
Prefix:
First Name:CLAES
Middle Name:R
Last Name:WYCKOFF
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 1:112 VALLEY TER
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8987
Mailing Address - Country:US
Mailing Address - Phone:570-460-3535
Mailing Address - Fax:
Practice Address - Street 1:1015 CONGDON AVE
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1117
Practice Address - Country:US
Practice Address - Phone:570-460-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor