Provider Demographics
NPI:1831697697
Name:PAVLAK, KEVIN (DC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:PAVLAK
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 1:4 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-1331
Mailing Address - Country:US
Mailing Address - Phone:862-377-9802
Mailing Address - Fax:
Practice Address - Street 1:18 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1141
Practice Address - Country:US
Practice Address - Phone:197-361-6455
Practice Address - Fax:973-616-4555
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00750700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor