Provider Demographics
NPI:1548337330
Name:NADLER, IVAN MARK (DC)
Entity type:Individual
Prefix:MR
First Name:IVAN
Middle Name:MARK
Last Name:NADLER
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 1:133C NORTH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070
Mailing Address - Country:US
Mailing Address - Phone:856-678-6607
Mailing Address - Fax:856-678-6870
Practice Address - Street 1:133C NORTH BROADWAY
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070
Practice Address - Country:US
Practice Address - Phone:856-678-6607
Practice Address - Fax:856-678-6870
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00216500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NA427029Medicare ID - Type Unspecified