Provider Demographics
NPI:1578542288
Name:CIVIL, PATRICIA (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:CIVIL
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 1:414 STATE RT 515
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07462-3027
Mailing Address - Country:US
Mailing Address - Phone:973-764-6800
Mailing Address - Fax:973-764-6800
Practice Address - Street 1:414 STATE RT 515
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:NJ
Practice Address - Zip Code:07462-3027
Practice Address - Country:US
Practice Address - Phone:973-764-6800
Practice Address - Fax:973-764-6800
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ013104VCDMedicare ID - Type UnspecifiedRENDERING ID NUMBER