Provider Demographics
NPI:1659485340
Name:WIKTORCHIK, JONATHAN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:WIKTORCHIK
Suffix:JR
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 1:2544 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:OTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18942-9620
Mailing Address - Country:US
Mailing Address - Phone:610-847-5141
Mailing Address - Fax:610-847-5142
Practice Address - Street 1:2544 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:OTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18942-9620
Practice Address - Country:US
Practice Address - Phone:610-847-5141
Practice Address - Fax:610-847-5142
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005398L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA144449Medicare PIN