Provider Demographics
NPI:1730229881
Name:EDELHAUSER, ROBERT FRANCIS (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FRANCIS
Last Name:EDELHAUSER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:FRANCIS
Other - Last Name:EDELHAUSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2116 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4672
Mailing Address - Country:US
Mailing Address - Phone:732-502-3270
Mailing Address - Fax:732-502-0004
Practice Address - Street 1:2116 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4672
Practice Address - Country:US
Practice Address - Phone:732-502-3270
Practice Address - Fax:732-502-0004
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC0022100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJED452398Medicare ID - Type UnspecifiedMEDICARE NUMBER