Provider Demographics
NPI:1770667214
Name:EASTMAN, SEAN ALI (D C)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:ALI
Last Name:EASTMAN
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 LAKEHURST RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8043
Mailing Address - Country:US
Mailing Address - Phone:732-505-8888
Mailing Address - Fax:732-505-1800
Practice Address - Street 1:529 LAKEHURST RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8043
Practice Address - Country:US
Practice Address - Phone:732-505-8888
Practice Address - Fax:732-505-1800
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00549900111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ031021Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER