Provider Demographics
NPI:1053525071
Name:HRYCENKO, MARIA (DC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:HRYCENKO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-1009
Mailing Address - Country:US
Mailing Address - Phone:732-974-0009
Mailing Address - Fax:
Practice Address - Street 1:2175 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1009
Practice Address - Country:US
Practice Address - Phone:732-974-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HR604152Medicare ID - Type Unspecified