Provider Demographics
NPI:1942394168
Name:PINE, FREDERICK (DC)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:PINE
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 1:824 MOUNTAIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-3438
Mailing Address - Country:US
Mailing Address - Phone:973-376-7600
Mailing Address - Fax:973-376-4606
Practice Address - Street 1:824 MOUNTAIN AVENUE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3438
Practice Address - Country:US
Practice Address - Phone:973-376-7600
Practice Address - Fax:973-376-4606
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC01016111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPI445333Medicare ID - Type Unspecified