Provider Demographics
NPI:1073886602
Name:DR, THEODORE HILLER
Entity Type:Organization
Organization Name:DR, THEODORE HILLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC PA
Authorized Official - Phone:732-846-8069
Mailing Address - Street 1:764 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1856
Mailing Address - Country:US
Mailing Address - Phone:732-846-8060
Mailing Address - Fax:732-846-0233
Practice Address - Street 1:764 EASTON AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1856
Practice Address - Country:US
Practice Address - Phone:732-846-8060
Practice Address - Fax:732-846-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC06321600111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty