Provider Demographics
NPI:1922005933
Name:BASS, SETH (DC)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:BASS
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 1:1430 HOOPER AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2895
Mailing Address - Country:US
Mailing Address - Phone:732-473-9532
Mailing Address - Fax:732-797-3279
Practice Address - Street 1:1430 HOOPER AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2895
Practice Address - Country:US
Practice Address - Phone:732-473-9532
Practice Address - Fax:732-797-3279
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU62426Medicare UPIN
NJ864487Medicare ID - Type Unspecified