Provider Demographics
NPI:1821395864
Name:DWORKIN, MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DWORKIN
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 1:180 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1917
Mailing Address - Country:US
Mailing Address - Phone:201-967-7900
Mailing Address - Fax:201-967-7901
Practice Address - Street 1:12 LINCOLN BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1175
Practice Address - Country:US
Practice Address - Phone:201-967-7900
Practice Address - Fax:201-967-7901
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor