Provider Demographics
NPI:1063569234
Name:NIERVA, PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:NIERVA
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 1:3830 PARK AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2562
Mailing Address - Country:US
Mailing Address - Phone:732-549-3993
Mailing Address - Fax:732-549-3991
Practice Address - Street 1:3830 PARK AVE STE 207
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2562
Practice Address - Country:US
Practice Address - Phone:732-549-3993
Practice Address - Fax:732-549-3991
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00607900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ067061Medicare ID - Type Unspecified
U93566Medicare UPIN