Provider Demographics
NPI:1679806715
Name:BCHAKJIAN, MARO R (DC)
Entity type:Individual
Prefix:DR
First Name:MARO
Middle Name:R
Last Name:BCHAKJIAN
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 1:4 BAYARD ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3304
Mailing Address - Country:US
Mailing Address - Phone:973-985-2836
Mailing Address - Fax:973-667-1502
Practice Address - Street 1:4 BAYARD ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3304
Practice Address - Country:US
Practice Address - Phone:973-985-2836
Practice Address - Fax:973-667-1502
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00402000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ065553Q97Medicare PIN
NJU93200Medicare UPIN