Provider Demographics
NPI:1528078953
Name:KAELIN, ROLAND F (DC)
Entity type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:F
Last Name:KAELIN
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 1:376 PITMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PITMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08071-1657
Mailing Address - Country:US
Mailing Address - Phone:856-582-2442
Mailing Address - Fax:856-589-7955
Practice Address - Street 1:376 PITMAN AVE
Practice Address - Street 2:
Practice Address - City:PITMAN
Practice Address - State:NJ
Practice Address - Zip Code:08071-1657
Practice Address - Country:US
Practice Address - Phone:856-582-2442
Practice Address - Fax:856-589-7955
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00185500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ443639Medicare ID - Type UnspecifiedCHIROPRACTOR