Provider Demographics
NPI:1952478216
Name:THERKELSEN, KATHLEEN (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:THERKELSEN
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 1:205 BORDENTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-1848
Mailing Address - Country:US
Mailing Address - Phone:732-727-3335
Mailing Address - Fax:732-727-3311
Practice Address - Street 1:205 BORDENTOWN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-1848
Practice Address - Country:US
Practice Address - Phone:732-727-3335
Practice Address - Fax:732-727-3311
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00368300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U24096Medicare UPIN
NJ635564Medicare ID - Type Unspecified