=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376515460
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENNIS T CASTERLINE DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 740 MANTUA PIKE
-----------------------------------------------------
City | WOODBURY HEIGHTS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08097-1149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-853-1114
-----------------------------------------------------
Fax | 856-845-1881
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 404 S MARION AVE
-----------------------------------------------------
City | WENONAH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08090-1930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 38MC00309100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------