Healthcare Provider Details

I. General information

NPI: 1821315920
Provider Name (Legal Business Name): JOHN M WOLKSTEIN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN M WOLKSTEIN BA, DC

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PLEASANT VALLEY WAY SUITE 102
WEST ORANGE NJ
07052-2956
US

IV. Provider business mailing address

1500 PLEASANT VALLEY WAY SUITE 102
WEST ORANGE NJ
07052-2956
US

V. Phone/Fax

Practice location:
  • Phone: 973-325-7225
  • Fax: 973-325-0825
Mailing address:
  • Phone: 973-325-7225
  • Fax: 973-325-0825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00347800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number38MC00347800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: