Provider Demographics
NPI:1538101118
Name:WHEATLEY-GOLDSTEIN, JOAN MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:MARIE
Last Name:WHEATLEY-GOLDSTEIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JOAN
Other - Middle Name:MARIE
Other - Last Name:WHEATLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:342 SCHRAALENBURGH RD
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1229
Mailing Address - Country:US
Mailing Address - Phone:201-387-6200
Mailing Address - Fax:201-439-1192
Practice Address - Street 1:342 SCHRAALENBURGH RD
Practice Address - Street 2:
Practice Address - City:HAWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07641-1229
Practice Address - Country:US
Practice Address - Phone:201-387-6200
Practice Address - Fax:201-439-1192
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00335500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJWH456465Medicare ID - Type Unspecified
NJT72981Medicare UPIN