Provider Demographics
NPI:1396843553
Name:ADAMCZYK, MICHAEL GREGORY (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GREGORY
Last Name:ADAMCZYK
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 1:23 TAYLOR AVE ROUTE 71
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736
Mailing Address - Country:US
Mailing Address - Phone:732-528-8884
Mailing Address - Fax:732-528-0716
Practice Address - Street 1:23 TAYLOR AVENUE ROUTE 71
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736
Practice Address - Country:US
Practice Address - Phone:732-528-8884
Practice Address - Fax:732-528-0716
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00184000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U10455Medicare UPIN
AD454846Medicare ID - Type Unspecified