Provider Demographics
NPI:1518239342
Name:PRITTING, PHILIP GEORGE
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:GEORGE
Last Name:PRITTING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MAIN ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-2963
Mailing Address - Country:US
Mailing Address - Phone:732-359-8263
Mailing Address - Fax:
Practice Address - Street 1:800 MAIN ST
Practice Address - Street 2:SUITE 109
Practice Address - City:BELMAR
Practice Address - State:NJ
Practice Address - Zip Code:07719-2963
Practice Address - Country:US
Practice Address - Phone:732-359-8263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31822111N00000X
NJ38MC00719200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor