Healthcare Provider Details

I. General information

NPI: 1720567118
Provider Name (Legal Business Name): CHRISTOPHER KOTWICKI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MERIDIAN RD
EATONTOWN NJ
07724-2242
US

IV. Provider business mailing address

7 MERIDIAN RD
EATONTOWN NJ
07724-2242
US

V. Phone/Fax

Practice location:
  • Phone: 732-935-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH12504
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: