Provider Demographics
NPI:1902083306
Name:HEWITT, DUSTIN L (DC)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:L
Last Name:HEWITT
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 1:14 RIDGEDALE AVE STE 262
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-1116
Mailing Address - Country:US
Mailing Address - Phone:973-944-1640
Mailing Address - Fax:973-761-2058
Practice Address - Street 1:14 RIDGEDALE AVE STE 262
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1116
Practice Address - Country:US
Practice Address - Phone:973-944-1640
Practice Address - Fax:973-761-2058
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00681700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor