Provider Demographics
NPI:1760437958
Name:THERKELSEN, RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:THERKELSEN
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 1:400 BELCHASE DR
Mailing Address - Street 2:SUITE 404
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-9731
Mailing Address - Country:US
Mailing Address - Phone:732-290-8950
Mailing Address - Fax:732-290-8952
Practice Address - Street 1:400 BELCHASE DR
Practice Address - Street 2:SUITE 404
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-9731
Practice Address - Country:US
Practice Address - Phone:732-290-8950
Practice Address - Fax:732-290-8952
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00166700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ455771TV9Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE ID
NJT72971Medicare UPIN