Provider Demographics
NPI:1629188099
Name:HAZEL, ROBERT H JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:HAZEL
Suffix:JR
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 1:220 VROOM AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-1628
Mailing Address - Country:US
Mailing Address - Phone:732-449-8530
Mailing Address - Fax:732-449-2369
Practice Address - Street 1:220 VROOM AVE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-1628
Practice Address - Country:US
Practice Address - Phone:732-449-8530
Practice Address - Fax:732-449-2369
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00136600111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ413011Medicare PIN