Provider Demographics
NPI:1235317603
Name:WARNER, THERESA (DC)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:WARNER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 BRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-3468
Mailing Address - Country:US
Mailing Address - Phone:732-295-0707
Mailing Address - Fax:732-295-1166
Practice Address - Street 1:3201 BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-3468
Practice Address - Country:US
Practice Address - Phone:732-295-0707
Practice Address - Fax:732-295-1166
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00434900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor