Provider Demographics
NPI:1053366435
Name:MCSWEENEY, TERRY MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:MICHAEL
Last Name:MCSWEENEY
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 1:600 MOUNT PROSPECT AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104
Mailing Address - Country:US
Mailing Address - Phone:973-485-2332
Mailing Address - Fax:973-485-6878
Practice Address - Street 1:600 MOUNT PROSPECT AVENUE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104
Practice Address - Country:US
Practice Address - Phone:973-485-2332
Practice Address - Fax:973-485-6878
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00355700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
091894Medicare ID - Type Unspecified