Provider Demographics
NPI:1013061852
Name:HAROLD K. DOE, JR, D.C., PA
Entity Type:Organization
Organization Name:HAROLD K. DOE, JR, D.C., PA
Other - Org Name:BLACKWOOD CHIROPRACTIC ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:DOEJR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-227-5422
Mailing Address - Street 1:55 EAST CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012
Mailing Address - Country:US
Mailing Address - Phone:856-227-5422
Mailing Address - Fax:856-227-2952
Practice Address - Street 1:55 EAST CHURCH STREET
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-227-5422
Practice Address - Fax:856-227-2952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00124900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ460466Medicare PIN