Provider Demographics
NPI:1710924931
Name:EICHENBAUM, JEFFREY (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:EICHENBAUM
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 1:206 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1727
Mailing Address - Country:US
Mailing Address - Phone:856-546-0055
Mailing Address - Fax:856-546-5404
Practice Address - Street 1:206 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1727
Practice Address - Country:US
Practice Address - Phone:856-546-0055
Practice Address - Fax:856-546-5404
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00544900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU64404Medicare UPIN
NJEI0033952Medicare ID - Type Unspecified