Provider Demographics
NPI:1407991185
Name:KEMENOSH, MARK S (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:KEMENOSH
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 1:3 JEFFERSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08021
Mailing Address - Country:US
Mailing Address - Phone:856-228-3100
Mailing Address - Fax:856-228-3108
Practice Address - Street 1:3 JEFFERSON DRIVE
Practice Address - Street 2:
Practice Address - City:LAUREL SPRINGS
Practice Address - State:NJ
Practice Address - Zip Code:08021
Practice Address - Country:US
Practice Address - Phone:856-228-3100
Practice Address - Fax:856-228-3108
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor