Provider Demographics
NPI:1477930618
Name:KANE, JACQUELYN MARIA (DC)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:MARIA
Last Name:KANE
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 1:1361 FAIRVIEW BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-1473
Mailing Address - Country:US
Mailing Address - Phone:856-544-3585
Mailing Address - Fax:856-544-3586
Practice Address - Street 1:1361 FAIRVIEW BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-1473
Practice Address - Country:US
Practice Address - Phone:856-544-3585
Practice Address - Fax:856-544-3586
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00725100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor