Provider Demographics
NPI:1568800399
Name:WYCKOFF CHIROPRACTIC AND WELLNESS
Entity Type:Organization
Organization Name:WYCKOFF CHIROPRACTIC AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WYCKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-517-9970
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:570-517-9970
Mailing Address - Fax:570-421-7084
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:570-517-9970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty