Healthcare Provider Details

I. General information

NPI: 1639357858
Provider Name (Legal Business Name): SAUTE KENYA DEAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 MARLTON PIKE E STE J51
CHERRY HILL NJ
08003-4106
US

IV. Provider business mailing address

1930 MARLTON PIKE E STE J51
CHERRY HILL NJ
08003-4106
US

V. Phone/Fax

Practice location:
  • Phone: 856-222-1322
  • Fax: 856-222-9632
Mailing address:
  • Phone: 856-222-1322
  • Fax: 856-222-9632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number38MC00681800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: