Provider Demographics
NPI:1700065737
Name:DANIEL J. DEJIANNE DC
Entity Type:Organization
Organization Name:DANIEL J. DEJIANNE DC
Other - Org Name:HERBERTSVILLE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEJIANNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-458-0800
Mailing Address - Street 1:1800 LANES MILL RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-5204
Mailing Address - Country:US
Mailing Address - Phone:732-458-0800
Mailing Address - Fax:732-458-5809
Practice Address - Street 1:1800 LANES MILL RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-5204
Practice Address - Country:US
Practice Address - Phone:732-458-0800
Practice Address - Fax:732-458-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00195700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1142909Medicaid
NJ1142909Medicaid