Provider Demographics
NPI:1144371691
Name:PAKENHAM, SIOBHAN ANN (DC)
Entity type:Individual
Prefix:DR
First Name:SIOBHAN
Middle Name:ANN
Last Name:PAKENHAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 FISCHER BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3090
Mailing Address - Country:US
Mailing Address - Phone:732-270-2811
Mailing Address - Fax:
Practice Address - Street 1:1171 FISCHER BLVD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3090
Practice Address - Country:US
Practice Address - Phone:732-270-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00666700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor