Provider Demographics
NPI:1386629236
Name:MAYCOCK, SIDNEY MANFRED JR (DC)
Entity type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:MANFRED
Last Name:MAYCOCK
Suffix:JR
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 1:103 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1817
Mailing Address - Country:US
Mailing Address - Phone:856-262-7234
Mailing Address - Fax:856-629-9226
Practice Address - Street 1:103 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-1817
Practice Address - Country:US
Practice Address - Phone:856-262-7234
Practice Address - Fax:856-629-9226
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00268100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ415128Medicare UPIN