Provider Demographics
NPI:1710907308
Name:ABAHAM, SHIJA (DC)
Entity Type:Individual
Prefix:
First Name:SHIJA
Middle Name:
Last Name:ABAHAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FOXCROFT WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-5733
Mailing Address - Country:US
Mailing Address - Phone:856-768-1156
Mailing Address - Fax:856-768-1157
Practice Address - Street 1:545 N ROUTE 73
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-9242
Practice Address - Country:US
Practice Address - Phone:856-768-1156
Practice Address - Fax:856-768-1157
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00631900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor