Provider Demographics
NPI:1427201888
Name:CULLEN, JEANETTE L (DC)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:L
Last Name:CULLEN
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 1:700 N BROAD ST
Mailing Address - Street 2:SUITE LL2
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-2310
Mailing Address - Country:US
Mailing Address - Phone:908-349-0677
Mailing Address - Fax:908-352-6865
Practice Address - Street 1:700 N BROAD ST
Practice Address - Street 2:SUITE LL2
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-2310
Practice Address - Country:US
Practice Address - Phone:908-349-0677
Practice Address - Fax:908-352-6865
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00438500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U57936Medicare UPIN