Charles M Dietrich, DC
Individual provider Active NPI Chiropractor · Keyport, NJ
NPI 1104985019 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1104985019
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 38MC00133800 (NJ)
- Practice address
- 250 Maple Place
Keyport, NJ 07735-1144 - Phone
- (732) 264-8900
- Fax
- (732) 264-0156
- NPI assigned
- Dec 6, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38MC00133800 | NJ | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 38MC00133800 | NJ | Yes |
Addresses
Primary practice location
250 Maple Place
Keyport, NJ 07735-1144
Mailing address
250 Maple Place
Keyport, NJ 07735-1144
Phone (732) 264-8900
Other providers in Keyport, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.