Provider Demographics
NPI:1205883600
Name:CZUPAK, MICHAEL ROMAN (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROMAN
Last Name:CZUPAK
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 1:1037 ROUTE 46 STE 203
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2459
Mailing Address - Country:US
Mailing Address - Phone:973-812-0202
Mailing Address - Fax:973-812-0505
Practice Address - Street 1:1037 ROUTE 46 STE 203
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2459
Practice Address - Country:US
Practice Address - Phone:973-812-0202
Practice Address - Fax:973-812-0505
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00628700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1748300POtherEMBLEM HEALTH PROVIDER
NJ0637432Medicaid
NJ2577448OtherWELLCARE
NJ60192386OtherNJ HEALTH PROVIDER