Healthcare Provider Details

I. General information

NPI: 1205991833
Provider Name (Legal Business Name): COLLEEN A. DRACHE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 RT. 517
GLENWOOD NJ
07418-0556
US

IV. Provider business mailing address

PO BOX 556
GLENWOOD NJ
07418-0556
US

V. Phone/Fax

Practice location:
  • Phone: 973-764-4411
  • Fax: 973-764-1452
Mailing address:
  • Phone: 973-764-4411
  • Fax: 973-764-1452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2939
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: