Provider Demographics
NPI:1417588435
Name:PRENTICE, NATHAN D (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:D
Last Name:PRENTICE
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 1:424 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-4654
Mailing Address - Country:US
Mailing Address - Phone:609-971-3500
Mailing Address - Fax:
Practice Address - Street 1:222 NEW RD STE 101
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1280
Practice Address - Country:US
Practice Address - Phone:609-829-5655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00768600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor