Provider Demographics
NPI:1679634026
Name:NEIVERTH, DOUGLAS ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ANDREW
Last Name:NEIVERTH
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 1:719 RTE 206 STE 102
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1529
Mailing Address - Country:US
Mailing Address - Phone:908-428-9565
Mailing Address - Fax:
Practice Address - Street 1:719 RTE 206 STE 102
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1529
Practice Address - Country:US
Practice Address - Phone:908-428-9565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX6K971Medicare ID - Type Unspecified
NYU79254Medicare UPIN