1467701920 NPI number — EAST COAST CHIROPRACTIC AND REHAB CENTER

Table of content: KATHERINE MARIE KUEHN R.D., L.D. (NPI 1083952402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467701920 NPI number — EAST COAST CHIROPRACTIC AND REHAB CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST COAST CHIROPRACTIC AND REHAB CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467701920
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
126 WEDGEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EGG HARBOR TOWNSHIP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08234-5266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-404-7797
Provider Business Mailing Address Fax Number:
609-404-7790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 CHRIS GAUPP DR
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
GALLOWAY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08205-4464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-404-7797
Provider Business Practice Location Address Fax Number:
609-404-7790
Provider Enumeration Date:
08/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
COZART
Authorized Official First Name:
TISHA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
609-404-7797

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  38MC00688400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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