Provider Demographics
NPI:1912996778
Name:KTSDC,PC
Entity Type:Organization
Organization Name:KTSDC,PC
Other - Org Name:LINCROFT CHIROPRACTIC & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SCHROETER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-933-4446
Mailing Address - Street 1:641 NEWMAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1721
Mailing Address - Country:US
Mailing Address - Phone:732-933-4446
Mailing Address - Fax:732-933-1622
Practice Address - Street 1:641 NEWMAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1721
Practice Address - Country:US
Practice Address - Phone:732-933-4446
Practice Address - Fax:732-933-1622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC00600500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0063924Medicaid
NJ089758Medicare ID - Type UnspecifiedMEDICARE GROUP #