Healthcare Provider Details

I. General information

NPI: 1982418828
Provider Name (Legal Business Name): SAMANTHA THELEN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 STATE ROUTE 35
RED BANK NJ
07701-5037
US

IV. Provider business mailing address

1455 BROAD ST STE 250
BLOOMFIELD NJ
07003-3066
US

V. Phone/Fax

Practice location:
  • Phone: 877-532-7837
  • Fax:
Mailing address:
  • Phone: 877-532-7837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00810800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: