Provider Demographics
NPI:1265496137
Name:EDEN, RICHARD D (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:EDEN
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 1:180 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6106
Mailing Address - Country:US
Mailing Address - Phone:908-687-3410
Mailing Address - Fax:908-687-3419
Practice Address - Street 1:410 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-9306
Practice Address - Country:US
Practice Address - Phone:908-687-3410
Practice Address - Fax:908-687-3419
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00144400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ512362Medicare ID - Type UnspecifiedPROVIDER NUMBER