Provider Demographics
NPI:1134494347
Name:KIM S.NAGLE, DC
Entity Type:Organization
Organization Name:KIM S.NAGLE, DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-714-9494
Mailing Address - Street 1:520 STOKES ROAD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2915
Mailing Address - Country:US
Mailing Address - Phone:609-714-9494
Mailing Address - Fax:609-714-9218
Practice Address - Street 1:520 STOKES ROAD
Practice Address - Street 2:SUITE B1
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2915
Practice Address - Country:US
Practice Address - Phone:609-714-9494
Practice Address - Fax:609-714-9218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1295785830OtherPRIMARY NPI
NJ1295785830OtherPRIMARY NPI