Provider Demographics
NPI:1366494221
Name:OHEA, JOHN M (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:OHEA
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 1:30 JACKSON ROAD
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055
Mailing Address - Country:US
Mailing Address - Phone:609-714-1899
Mailing Address - Fax:609-714-8218
Practice Address - Street 1:30 JACKSON ROAD
Practice Address - Street 2:SUITE A-2
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055
Practice Address - Country:US
Practice Address - Phone:609-714-1899
Practice Address - Fax:609-714-8218
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02794111N00000X
NJ38MC00279400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U36848Medicare UPIN
421398Medicare ID - Type Unspecified