Provider Demographics
NPI:1699773846
Name:MYCHALUK, PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:MYCHALUK
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 1:355 LANCASTER AVE
Mailing Address - Street 2:BLDG C
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1547
Mailing Address - Country:US
Mailing Address - Phone:610-649-9637
Mailing Address - Fax:610-649-6430
Practice Address - Street 1:355 LANCASTER AVE
Practice Address - Street 2:BLDG C
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1547
Practice Address - Country:US
Practice Address - Phone:610-649-9637
Practice Address - Fax:610-649-6430
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 002095 L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMY 143924Medicare ID - Type Unspecified