Provider Demographics
NPI:1982811469
Name:HAJDUK, KEVIN JOHN (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOHN
Last Name:HAJDUK
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 1:1680 HAMNER AVE
Mailing Address - Street 2:#33
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-2932
Mailing Address - Country:US
Mailing Address - Phone:951-734-2100
Mailing Address - Fax:
Practice Address - Street 1:1680 HAMNER AVE
Practice Address - Street 2:#33
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-2932
Practice Address - Country:US
Practice Address - Phone:951-734-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT05684Medicare ID - Type UnspecifiedID OF REFERRING PHYSICIAN
CADC0152250Medicare UPIN