Healthcare Provider Details

I. General information

NPI: 1902869142
Provider Name (Legal Business Name): JOHN DANIEL KRISCIUNAS JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 02/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 ROUTE 168 SUITE 104
TURNERSVILLE NJ
08012-3215
US

IV. Provider business mailing address

860 ROUTE 168 SUITE 104
TURNERSVILLE NJ
08012-3215
US

V. Phone/Fax

Practice location:
  • Phone: 856-401-9550
  • Fax: 856-401-9551
Mailing address:
  • Phone: 856-401-9550
  • Fax: 856-401-9551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number38MC00486700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC006573L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: