Provider Demographics
NPI:1518065499
Name:MCGUNNIGLE, JEFFREY HAMILTON (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:HAMILTON
Last Name:MCGUNNIGLE
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 1:450 W CRYSTAL LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2803
Mailing Address - Country:US
Mailing Address - Phone:856-310-4445
Mailing Address - Fax:859-310-4404
Practice Address - Street 1:450 CRYSTAL LAKE AVENUE
Practice Address - Street 2:
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08108
Practice Address - Country:US
Practice Address - Phone:856-310-4445
Practice Address - Fax:859-310-4404
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00317400111N00000X
PADC002708L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ103214OtherMEDICARE GROUP NUMBER