Provider Demographics
NPI:1629053533
Name:THUM, CARLEEN A
Entity Type:Individual
Prefix:
First Name:CARLEEN
Middle Name:A
Last Name:THUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 ORCHARD RD.
Mailing Address - Street 2:STE 4
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558
Mailing Address - Country:US
Mailing Address - Phone:609-250-3188
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:88 ORCHARD RD STE 4
Practice Address - Street 2:
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-2642
Practice Address - Country:US
Practice Address - Phone:609-250-3188
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00561700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ040857TQQOtherRENDERING PROVIDER #
NJ040857TQQOtherRENDERING PROVIDER #
NJ4263481Medicare UPIN