Healthcare Provider Details

I. General information

NPI: 1255348132
Provider Name (Legal Business Name): EDWARD C SUTTERLEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 CTY RD 513
CALIFON NJ
07830
US

IV. Provider business mailing address

438 CTY RD 513
CALIFON NJ
07830
US

V. Phone/Fax

Practice location:
  • Phone: 908-832-2099
  • Fax: 908-832-6017
Mailing address:
  • Phone: 908-832-2099
  • Fax: 908-832-6017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00334500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: