Provider Demographics
NPI:1114326063
Name:CROASDALE, JEFF (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:CROASDALE
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 1:953 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-3328
Mailing Address - Country:US
Mailing Address - Phone:732-539-1031
Mailing Address - Fax:
Practice Address - Street 1:557 S ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2258
Practice Address - Country:US
Practice Address - Phone:732-997-4988
Practice Address - Fax:732-583-4704
Is Sole Proprietor?:No
Enumeration Date:2014-08-16
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00719400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor