Provider Demographics
NPI:1891747549
Name:REDMOND, JENNIFER ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:REDMOND
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 1:27 ANDERSON ST
Mailing Address - Street 2:APT A
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-1818
Mailing Address - Country:US
Mailing Address - Phone:908-300-8800
Mailing Address - Fax:
Practice Address - Street 1:1 EASTERN AVE
Practice Address - Street 2:2ND FLOOR EAST
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2552
Practice Address - Country:US
Practice Address - Phone:908-300-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00625200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ078802U78Medicare PIN