Provider Demographics
NPI:1841222551
Name:BURDEN, JONATHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:BURDEN
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 1:234 INDUSTRIAL WAY W
Mailing Address - Street 2:STE A200
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-4244
Mailing Address - Country:US
Mailing Address - Phone:732-747-7110
Mailing Address - Fax:
Practice Address - Street 1:234 INDUSTRIAL WAY W
Practice Address - Street 2:STE A200
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-4244
Practice Address - Country:US
Practice Address - Phone:732-747-7110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00518200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJV04041Medicare UPIN