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General NPI Number Information
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NPI Number | 1285171397
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Entity Type | Organization
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Legal Business Name | PURE CHIROPRACTIC
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Dates
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Enumeration Date | 01/26/2017
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 1912 RTE 35 102
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City | OAKHURST
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State | NJ
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Zip | 07755-2768
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Country | US
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Telephone | 732-778-8862
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Fax |
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Provider Business Mailing Address
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Address Line | 1912 RTE 35 102
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City | OAKHURST
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State | NJ
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Zip | 07755-2768
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Country | US
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Telephone | 732-778-8862
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEVIN FISCHER
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Credential | DC
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Telephone | 732-778-8862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00742
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License Number State | NJ
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