Provider Demographics
NPI:1780160754
Name:OSENENKO, JAMES S (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:OSENENKO
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 1:31 N MAPLE AVE APT 474
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1738
Mailing Address - Country:US
Mailing Address - Phone:609-207-8634
Mailing Address - Fax:
Practice Address - Street 1:73 NAUTILUS DR
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2448
Practice Address - Country:US
Practice Address - Phone:609-597-4755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00754700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor