Healthcare Provider Details

I. General information

NPI: 1831118975
Provider Name (Legal Business Name): DR BETH ANN WHITE FAMILY CHIRO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 ROUTE 88 EAST
BRICK NJ
08724-3225
US

IV. Provider business mailing address

2023 ROUTE 88 EAST
BRICK NJ
08724-3225
US

V. Phone/Fax

Practice location:
  • Phone: 732-458-5885
  • Fax: 732-458-6488
Mailing address:
  • Phone: 732-458-5885
  • Fax: 732-458-6488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC04315
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00786800
License Number StateNJ

VIII. Authorized Official

Name: DR. BETH ANN WHITE-MANESS
Title or Position: OWNER OPERATOR
Credential: DC
Phone: 732-458-5885