Provider Demographics
NPI:1376702159
Name:DWECK, JAN (DC RN)
Entity Type:Individual
Prefix:MR
First Name:JAN
Middle Name:
Last Name:DWECK
Suffix:
Gender:M
Credentials:DC RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 TRANQUILITY RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901
Mailing Address - Country:US
Mailing Address - Phone:917-596-0818
Mailing Address - Fax:
Practice Address - Street 1:5 CLAREMONT LN
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-7011
Practice Address - Country:US
Practice Address - Phone:845-368-3987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8631111N00000X, 111NS0005X
NY640847163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician