Healthcare Provider Details

I. General information

NPI: 1730617226
Provider Name (Legal Business Name): OGECHI UKAEGBU DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 05/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 CONVERY BLVD
PERTH AMBOY NJ
08861-2584
US

IV. Provider business mailing address

1570 ANDREW ST
UNION NJ
07083-5219
US

V. Phone/Fax

Practice location:
  • Phone: 732-324-4300
  • Fax: 732-324-8211
Mailing address:
  • Phone: 908-463-2530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number38MC00745600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00745600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: