Provider Demographics
NPI:1659454981
Name:WIKLINSKI, STEPHEN LOUIS (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LOUIS
Last Name:WIKLINSKI
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 1:2 DEWOLF RD
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7013
Mailing Address - Country:US
Mailing Address - Phone:201-750-0929
Mailing Address - Fax:
Practice Address - Street 1:54 MAIN ST
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-3660
Practice Address - Country:US
Practice Address - Phone:914-631-4998
Practice Address - Fax:914-631-3516
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010095-1111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ007712Medicare ID - Type Unspecified