Provider Demographics
NPI:1720186174
Name:DREICER, SHAR G (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAR
Middle Name:G
Last Name:DREICER
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 1:316 BROAD ST
Mailing Address - Street 2:STE 7
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2154
Mailing Address - Country:US
Mailing Address - Phone:732-758-9666
Mailing Address - Fax:732-758-1091
Practice Address - Street 1:316 BROAD ST
Practice Address - Street 2:SUITE 7
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2154
Practice Address - Country:US
Practice Address - Phone:732-758-9666
Practice Address - Fax:732-758-1091
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ157414OtherPTAN
NYX40531OtherLICENCE
NJ408687Medicare PIN
NJ157414OtherPTAN