Healthcare Provider Details

I. General information

NPI: 1134494347
Provider Name (Legal Business Name): KIM S.NAGLE, DC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 STOKES ROAD SUITE B1
MEDFORD NJ
08055-2915
US

IV. Provider business mailing address

520 STOKES ROAD SUITE B1
MEDFORD NJ
08055-2915
US

V. Phone/Fax

Practice location:
  • Phone: 609-714-9494
  • Fax: 609-714-9218
Mailing address:
  • Phone: 609-714-9494
  • Fax: 609-714-9218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC02575
License Number StateNJ

VIII. Authorized Official

Name: KIM S NAGLE
Title or Position: OWNER, CHIROPRACTOR
Credential: DC
Phone: 609-714-9494