Healthcare Provider Details

I. General information

NPI: 1376515460
Provider Name (Legal Business Name): DENNIS T CASTERLINE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 MANTUA PIKE
WOODBURY HEIGHTS NJ
08097-1149
US

IV. Provider business mailing address

404 S MARION AVE
WENONAH NJ
08090-1930
US

V. Phone/Fax

Practice location:
  • Phone: 856-853-1114
  • Fax: 856-845-1881
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00309100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: