Provider Demographics
NPI:1336188564
Name:WINTERBOTTOM, CHAD RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:RICHARD
Last Name:WINTERBOTTOM
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 1:5429 HARDING HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-2203
Mailing Address - Country:US
Mailing Address - Phone:609-625-2006
Mailing Address - Fax:609-625-1995
Practice Address - Street 1:5429 HARDING HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-2203
Practice Address - Country:US
Practice Address - Phone:609-625-2006
Practice Address - Fax:609-625-1995
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00567700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3957920OtherAETNA
NJ2011312000OtherAMERIHEALTH
NJ3957920OtherAETNA