Provider Demographics
NPI:1336622745
Name:PREDTECHENSKYI, MYKYTA (DC)
Entity Type:Individual
Prefix:
First Name:MYKYTA
Middle Name:
Last Name:PREDTECHENSKYI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:PREDTECHENSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:621 23RD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1767
Mailing Address - Country:US
Mailing Address - Phone:408-786-8808
Mailing Address - Fax:
Practice Address - Street 1:1530A 5TH ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-1713
Practice Address - Country:US
Practice Address - Phone:510-725-1179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor