Provider Demographics
NPI:1710262100
Name:KOUEFATI, RICHARD ADEL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ADEL
Last Name:KOUEFATI
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 1:3 JESSICA WAY
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5489
Mailing Address - Country:US
Mailing Address - Phone:973-634-7587
Mailing Address - Fax:
Practice Address - Street 1:3 JESSICA WAY
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5489
Practice Address - Country:US
Practice Address - Phone:973-634-7587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00690400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor