Provider Demographics
NPI:1376678664
Name:WULSTER, TERESA A (DC)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:A
Last Name:WULSTER
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 1:35 W MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2174
Mailing Address - Country:US
Mailing Address - Phone:973-625-2600
Mailing Address - Fax:
Practice Address - Street 1:35 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2174
Practice Address - Country:US
Practice Address - Phone:973-625-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00237300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ536593TWSMedicare PIN