Provider Demographics
NPI:1497844534
Name:DEMOULIN, ELLEN T (DC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:T
Last Name:DEMOULIN
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 1:52 TUCKAHOE RD
Mailing Address - Street 2:
Mailing Address - City:MARMORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08223
Mailing Address - Country:US
Mailing Address - Phone:609-390-8490
Mailing Address - Fax:609-845-1850
Practice Address - Street 1:52 TUCKAHOE RD
Practice Address - Street 2:
Practice Address - City:MARMORA
Practice Address - State:NJ
Practice Address - Zip Code:08223
Practice Address - Country:US
Practice Address - Phone:609-390-8490
Practice Address - Fax:609-845-1850
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00336900111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
038977RSVOtherMEDICARE PTAN