Provider Demographics
NPI:1063503092
Name:MCGOUGH, EILEEN (DC)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:
Last Name:MCGOUGH
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 1:124 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2049
Mailing Address - Country:US
Mailing Address - Phone:732-462-6686
Mailing Address - Fax:732-462-5512
Practice Address - Street 1:124 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2049
Practice Address - Country:US
Practice Address - Phone:732-462-6686
Practice Address - Fax:732-462-5512
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMCO3315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ141847877OtherIRS TAXPAYER I.D. NUMBER
NJ605906Medicare ID - Type Unspecified