Provider Demographics
NPI:1396813515
Name:GIACALONE, SUSAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:GIACALONE
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 1:180 HOWARD BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:MT ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07856-2318
Mailing Address - Country:US
Mailing Address - Phone:973-398-8370
Mailing Address - Fax:973-398-8332
Practice Address - Street 1:181 HOWARD BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:MT ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07856-2314
Practice Address - Country:US
Practice Address - Phone:973-398-8370
Practice Address - Fax:973-398-8332
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00475300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22-3736982OtherTAX ID