Healthcare Provider Details

I. General information

NPI: 1659454981
Provider Name (Legal Business Name): STEPHEN LOUIS WIKLINSKI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 MAIN ST
TARRYTOWN NY
10591-3660
US

IV. Provider business mailing address

2 DEWOLF RD
OLD TAPPAN NJ
07675-7013
US

V. Phone/Fax

Practice location:
  • Phone: 914-631-4998
  • Fax: 914-631-3516
Mailing address:
  • Phone: 201-750-0929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberX010095-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: