=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992799373
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD TODD KIRSTEIN D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2005
-----------------------------------------------------
Last Update Date | 04/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 630 S BREWSTER RD
-----------------------------------------------------
City | VINELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08361-7801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-692-9299
-----------------------------------------------------
Fax | 856-696-3870
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 630 S BREWSTER RD UNIT B2
-----------------------------------------------------
City | VINELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08361-7801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-692-9299
-----------------------------------------------------
Fax | 856-696-3870
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | MC 02778
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------