Provider Demographics
NPI:1578692075
Name:PLUMP, PAUL ALBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALBERT
Last Name:PLUMP
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 1:403 HOOPER AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7701
Mailing Address - Country:US
Mailing Address - Phone:732-349-4646
Mailing Address - Fax:732-349-4787
Practice Address - Street 1:403 HOOPER AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7701
Practice Address - Country:US
Practice Address - Phone:732-349-4646
Practice Address - Fax:732-349-4787
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00235100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ479167Medicare ID - Type UnspecifiedPROVIDER #