Provider Demographics
NPI:1376515460
Name:CASTERLINE, DENNIS T (DC)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:T
Last Name:CASTERLINE
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 1:404 S MARION AVE
Mailing Address - Street 2:
Mailing Address - City:WENONAH
Mailing Address - State:NJ
Mailing Address - Zip Code:08090-1930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:740 MANTUA PIKE
Practice Address - Street 2:
Practice Address - City:WOODBURY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08097-1149
Practice Address - Country:US
Practice Address - Phone:856-853-1114
Practice Address - Fax:856-845-1881
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00309100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0105499000OtherAMERIHEALTH/BLUE CROSS
NJ0545120OtherAETNA
NJ6298109Medicaid
NJ0000101208OtherLOCAL 825/OPERATING ENGIN
NJT72977Medicare UPIN
NJ455865CMQMedicare ID - Type Unspecified