Provider Demographics
NPI:1760538680
Name:CHUDKOWSKI, STEPHEN P (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:CHUDKOWSKI
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 1:960 ROUTE 9 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879
Mailing Address - Country:US
Mailing Address - Phone:732-727-0690
Mailing Address - Fax:732-727-5567
Practice Address - Street 1:960 US HIGHWAY 9
Practice Address - Street 2:SAYREVILLE PLAZA
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-3310
Practice Address - Country:US
Practice Address - Phone:732-727-0690
Practice Address - Fax:732-727-5567
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00421900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU33922Medicare UPIN