Provider Demographics
NPI:1023211786
Name:DEL MAGE, KIMBERLY ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:DEL MAGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEARS DR
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3515
Mailing Address - Country:US
Mailing Address - Phone:201-261-5220
Mailing Address - Fax:201-261-5223
Practice Address - Street 1:1 SEARS DR
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3515
Practice Address - Country:US
Practice Address - Phone:201-261-5220
Practice Address - Fax:201-261-5223
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001607111N00000X
NJ38MC00706300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTV04541Medicare UPIN
CT350001396Medicare ID - Type Unspecified