Provider Demographics
NPI:1508887654
Name:RYKACZEWSKI, PAUL G (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:G
Last Name:RYKACZEWSKI
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 1:2 SHEPPARD RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4787
Mailing Address - Country:US
Mailing Address - Phone:856-874-0080
Mailing Address - Fax:856-874-0085
Practice Address - Street 1:2 SHEPPARD RD
Practice Address - Street 2:SUITE 102
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4787
Practice Address - Country:US
Practice Address - Phone:856-874-0080
Practice Address - Fax:856-874-0085
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00469100111N00000X
PADC006211L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7448309Medicaid
802973Medicare ID - Type Unspecified
NJ7448309Medicaid