Provider Demographics
NPI:1992238729
Name:ALEXANDER J. KISHYK, D.C. LLC
Entity type:Organization
Organization Name:ALEXANDER J. KISHYK, D.C. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KISHYK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-526-5868
Mailing Address - Street 1:373 E MAIN ST STE 10
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3143
Mailing Address - Country:US
Mailing Address - Phone:908-526-5868
Mailing Address - Fax:908-252-9826
Practice Address - Street 1:373 E MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-3143
Practice Address - Country:US
Practice Address - Phone:908-526-5868
Practice Address - Fax:908-252-9826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-08
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00381300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty