Healthcare Provider Details

I. General information

NPI: 1720117252
Provider Name (Legal Business Name): CRESTWOOD MANCHESTER CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 HIGHWAY 70
MANCHESTER NJ
08759
US

IV. Provider business mailing address

1229 JASAM CT
TOMS RIVER NJ
08755-1356
US

V. Phone/Fax

Practice location:
  • Phone: 732-657-2225
  • Fax: 732-657-2598
Mailing address:
  • Phone: 732-240-4810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. SHARI DLOSS
Title or Position: DR OWNER
Credential: D.C.
Phone: 732-657-2225