Provider Demographics
NPI:1861591513
Name:DEICHMAN, JEREMY JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:JOHN
Last Name:DEICHMAN
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 1:567 MANTOLOKING RD
Mailing Address - Street 2:UNIT 7
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-5620
Mailing Address - Country:US
Mailing Address - Phone:732-746-3160
Mailing Address - Fax:732-746-3261
Practice Address - Street 1:567 MANTOLOKING RD
Practice Address - Street 2:UNIT 7
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-5620
Practice Address - Country:US
Practice Address - Phone:732-746-3160
Practice Address - Fax:732-746-3261
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00635800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ088167Medicare ID - Type Unspecified