Provider Demographics
NPI:1639426687
Name:PONCHICK, ADAM JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JAY
Last Name:PONCHICK
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 1:34 HEMLOCK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-1314
Mailing Address - Country:US
Mailing Address - Phone:203-605-9981
Mailing Address - Fax:
Practice Address - Street 1:59 ELM ST
Practice Address - Street 2:SUITE 110
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2047
Practice Address - Country:US
Practice Address - Phone:203-909-6173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001912111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor