=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922112549
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL STEPHEN KIRK JR. D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2006
-----------------------------------------------------
Last Update Date | 12/29/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 208 CREEK CROSSING BLVD
-----------------------------------------------------
City | HAINESPORT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08036-2766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-727-8300
-----------------------------------------------------
Fax | 856-727-8346
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 208 CREEK CROSSING BLVD
-----------------------------------------------------
City | HAINESPORT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08036-2766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-727-8300
-----------------------------------------------------
Fax | 609-667-7263
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 38MC00578200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------