Healthcare Provider Details

I. General information

NPI: 1366494221
Provider Name (Legal Business Name): JOHN M OHEA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/28/2015
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: 609-714-1899
  • Fax: 609-714-8218
Mailing address:
  • Phone: 609-714-1899
  • Fax: 609-714-8218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC02794
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00279400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: