Provider Demographics
NPI:1609172832
Name:DISTLER, MICHAEL JAMES (DC, CCSP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:DISTLER
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GREENVALE RD
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2234
Mailing Address - Country:US
Mailing Address - Phone:203-241-4574
Mailing Address - Fax:
Practice Address - Street 1:56 N HADDON AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2438
Practice Address - Country:US
Practice Address - Phone:856-240-7529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-05
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00760100111NS0005X
NYN-A111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NI0900XChiropractic ProvidersChiropractorInternist