Provider Demographics
NPI:1922112549
Name:KIRK, MICHAEL STEPHEN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:KIRK
Suffix:JR
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 1:208 CREEK CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-2766
Mailing Address - Country:US
Mailing Address - Phone:856-727-8300
Mailing Address - Fax:609-667-7263
Practice Address - Street 1:208 CREEK CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036-2766
Practice Address - Country:US
Practice Address - Phone:856-727-8300
Practice Address - Fax:856-727-8346
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00578200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ001745107OtherHIGHMARK BLUESHIELD GROUP
NJ7272582OtherAETNA PPO
NJ001639659OtherHIGHMARK BLUESHIELD PROVI
NJ2410673000OtherAMERIHEALTH HMO GROUP
NJ3557463OtherAETNA HMO
NJ2314204000OtherAMERIHEALTH HMO PROVIDER