Healthcare Provider Details

I. General information

NPI: 1295785830
Provider Name (Legal Business Name): KIM SUSAN NAGLE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 JACKSON ROAD SUITE A-2
MEDFORD NJ
08055
US

IV. Provider business mailing address

30 JACKSON ROAD SUITE A-2
MEDFORD NJ
08055
US

V. Phone/Fax

Practice location:
  • Phone: 609-714-9494
  • Fax: 609-714-9218
Mailing address:
  • Phone: 609-714-9494
  • Fax: 609-714-8218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00257500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: