Provider Demographics
NPI:1851339097
Name:DOE, EDWIN CHESTER SR (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:CHESTER
Last Name:DOE
Suffix:SR
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 1:1101 RICHMOND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:POINT PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-3010
Mailing Address - Country:US
Mailing Address - Phone:732-892-2365
Mailing Address - Fax:732-892-4843
Practice Address - Street 1:1101 RICHMOND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:POINT PLEASANT BEACH
Practice Address - State:NJ
Practice Address - Zip Code:08742-3010
Practice Address - Country:US
Practice Address - Phone:732-892-2365
Practice Address - Fax:732-892-4843
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC001273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1126202Medicaid
NJ35004OtherRR MEDICARE
NJ4348559OtherEPDB
NJT72960Medicare UPIN
NJ4348559OtherEPDB