Healthcare Provider Details

I. General information

NPI: 1568842342
Provider Name (Legal Business Name): DAVID E KOENTOP D.C., DACNB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2399 ROUTE 34 BLDG A SUITE 5
MANASQUAN NJ
08736-1500
US

IV. Provider business mailing address

404 LIPPINCOTT DR
MARLTON NJ
08053-4112
US

V. Phone/Fax

Practice location:
  • Phone: 732-528-5533
  • Fax: 732-528-0360
Mailing address:
  • Phone: 856-782-3300
  • Fax: 856-504-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCHIR009216
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number04751
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number38MC00715200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: