Healthcare Provider Details

I. General information

NPI: 1326261603
Provider Name (Legal Business Name): TERRI OLOUGHLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E NORTHFIELD RD
LIVINGSTON NJ
07039-4505
US

IV. Provider business mailing address

212 E NORTHFIELD RD
LIVINGSTON NJ
07039-4505
US

V. Phone/Fax

Practice location:
  • Phone: 973-740-0477
  • Fax: 973-740-0844
Mailing address:
  • Phone: 973-740-0477
  • Fax: 973-740-0844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC 1859
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: