Provider Demographics
NPI:1205991833
Name:DRACHE, COLLEEN A (DC)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:A
Last Name:DRACHE
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:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07418-0556
Mailing Address - Country:US
Mailing Address - Phone:973-764-4411
Mailing Address - Fax:973-764-1452
Practice Address - Street 1:701 RT. 517
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07418-0556
Practice Address - Country:US
Practice Address - Phone:973-764-4411
Practice Address - Fax:973-764-1452
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0016626OtherGHI
NJ0016626OtherGHI