Provider Demographics
NPI:1992864466
Name:SUDNYKOVYCH, JAYSEN TORREY (DC)
Entity Type:Individual
Prefix:
First Name:JAYSEN
Middle Name:TORREY
Last Name:SUDNYKOVYCH
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 1:8409 N MILITARY TRL
Mailing Address - Street 2:SUITE 113
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6316
Mailing Address - Country:US
Mailing Address - Phone:561-630-9495
Mailing Address - Fax:561-253-0845
Practice Address - Street 1:8409 N MILITARY TRL
Practice Address - Street 2:SUITE 113
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6316
Practice Address - Country:US
Practice Address - Phone:561-630-9495
Practice Address - Fax:561-253-0845
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFV608YMedicare PIN