Provider Demographics
NPI:1114014271
Name:DEMOULIN CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:DEMOULIN CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEMOULIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-390-8490
Mailing Address - Street 1:52 TUCKAHOE RD
Mailing Address - Street 2:
Mailing Address - City:MARMORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08223-1206
Mailing Address - Country:US
Mailing Address - Phone:609-390-8490
Mailing Address - Fax:609-845-1850
Practice Address - Street 1:52 TUCKAHOE RD
Practice Address - Street 2:
Practice Address - City:MARMORA
Practice Address - State:NJ
Practice Address - Zip Code:08223-1206
Practice Address - Country:US
Practice Address - Phone:609-390-8490
Practice Address - Fax:609-845-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00282200111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
070080OtherMEDICARE PTAN