Provider Demographics
NPI:1639276652
Name:FITCH, JEFFREY MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARK
Last Name:FITCH
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 1:2022 STATE ROUTE 71
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-2291
Mailing Address - Country:US
Mailing Address - Phone:732-449-8330
Mailing Address - Fax:732-449-2144
Practice Address - Street 1:2022 STATE ROUTE 71
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-2291
Practice Address - Country:US
Practice Address - Phone:732-449-8330
Practice Address - Fax:732-449-2144
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6486606Medicaid
NJ452459Medicare ID - Type Unspecified
NJ6486606Medicaid