Provider Demographics
NPI:1386780872
Name:TAKACS, MICHELE (DC)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:TAKACS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 STATE ROUTE 15
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:07848-2406
Mailing Address - Country:US
Mailing Address - Phone:973-383-5052
Mailing Address - Fax:
Practice Address - Street 1:82 STATE ROUTE 15
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:NJ
Practice Address - Zip Code:07848-2406
Practice Address - Country:US
Practice Address - Phone:973-383-5052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMCO2840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJTA452481Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER