Healthcare Provider Details

I. General information

NPI: 1174676167
Provider Name (Legal Business Name): XERXES OSHIDAR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MADISON AVE
LUMBERTON NJ
08048-2901
US

IV. Provider business mailing address

227 MADISON AVE
LUMBERTON NJ
08048-2901
US

V. Phone/Fax

Practice location:
  • Phone: 609-261-7562
  • Fax: 609-261-7562
Mailing address:
  • Phone: 609-261-7562
  • Fax: 609-261-7562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCO9080-5B
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC00580900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: