Provider Demographics
NPI:1932139870
Name:KOOREMAN, ALAN JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JOHN
Last Name:KOOREMAN
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 1:644 GODWIN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1405
Mailing Address - Country:US
Mailing Address - Phone:201-445-6200
Mailing Address - Fax:201-445-6170
Practice Address - Street 1:644 GODWIN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1405
Practice Address - Country:US
Practice Address - Phone:201-445-6200
Practice Address - Fax:201-445-6170
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ621688Medicare ID - Type Unspecified