Healthcare Provider Details

I. General information

NPI: 1356403638
Provider Name (Legal Business Name): JAIMEE C KUKLA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PRINCESS RD SUITE 2A
LAWRENCEVILLE NJ
08648-2302
US

IV. Provider business mailing address

2 PRINCESS RD SUITE 2A
LAWRENCEVILLE NJ
08648-2302
US

V. Phone/Fax

Practice location:
  • Phone: 609-844-9800
  • Fax: 609-844-9848
Mailing address:
  • Phone: 609-844-9800
  • Fax: 609-844-9848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC05715
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: