Provider Demographics
NPI:1083755490
Name:ROBINSON, JEREMY J (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:J
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1621
Mailing Address - Country:US
Mailing Address - Phone:908-428-8001
Mailing Address - Fax:908-354-8012
Practice Address - Street 1:400 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1621
Practice Address - Country:US
Practice Address - Phone:908-428-8001
Practice Address - Fax:908-354-8012
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001493111N00000X
NJ38MC00616700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350001355Medicare ID - Type Unspecified