Provider Demographics
NPI:1689264632
Name:EIGENMANN, SLADE SCOTT
Entity Type:Individual
Prefix:
First Name:SLADE
Middle Name:SCOTT
Last Name:EIGENMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MILLERS LN
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9500
Mailing Address - Country:US
Mailing Address - Phone:973-216-0164
Mailing Address - Fax:
Practice Address - Street 1:308 SPRINGFIELD AVE STE 1
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1278
Practice Address - Country:US
Practice Address - Phone:908-771-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00777900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor