Healthcare Provider Details

I. General information

NPI: 1518082676
Provider Name (Legal Business Name): EMMA LUCIA YEPEZ-ZIEGENBALG D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 05/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 INMAN AVE
COLONIA NJ
07067-1000
US

IV. Provider business mailing address

35 JEFFERY RD
COLONIA NJ
07067-2413
US

V. Phone/Fax

Practice location:
  • Phone: 732-499-9191
  • Fax: 732-499-8618
Mailing address:
  • Phone: 732-499-9191
  • Fax: 732-499-8618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC04763
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: