Provider Demographics
NPI:1497817225
Name:CHESNEY, EDWARD PAUL (DC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:PAUL
Last Name:CHESNEY
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 1:1060 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2397
Mailing Address - Country:US
Mailing Address - Phone:201-988-6169
Mailing Address - Fax:862-591-1421
Practice Address - Street 1:1060 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2397
Practice Address - Country:US
Practice Address - Phone:201-988-6169
Practice Address - Fax:862-591-1421
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC002412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1183702Medicaid
NJ1183702Medicaid
NJT45132Medicare UPIN