Healthcare Provider Details

I. General information

NPI: 1043544703
Provider Name (Legal Business Name): AUGUSTE DUVERNEAU D,C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 ENGLE ST
ENGLEWOOD NJ
07631-2463
US

IV. Provider business mailing address

242 ENGLE ST
ENGLEWOOD NJ
07631-2463
US

V. Phone/Fax

Practice location:
  • Phone: 201-541-5410
  • Fax:
Mailing address:
  • Phone: 201-541-5410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00528900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number38MC00528900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number38MC00528900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: