Provider Demographics
NPI:1376602904
Name:FORD, JOHN T (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:FORD
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 1:80 MILL ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-1411
Mailing Address - Country:US
Mailing Address - Phone:973-579-1660
Mailing Address - Fax:973-579-9185
Practice Address - Street 1:80 MILL ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1411
Practice Address - Country:US
Practice Address - Phone:973-579-1660
Practice Address - Fax:973-579-9185
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC02219111N00000X
SC2649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ603124S04Medicare PIN
NJT93195Medicare UPIN