Provider Demographics
NPI:1104126267
Name:COUGHLIN, DEVON MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:DEVON
Middle Name:MATTHEW
Last Name:COUGHLIN
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 1:4516 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2210
Mailing Address - Country:US
Mailing Address - Phone:856-552-0570
Mailing Address - Fax:
Practice Address - Street 1:4516 CHURCH RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2210
Practice Address - Country:US
Practice Address - Phone:856-552-0570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-23
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010321111N00000X
NJ38MC00687000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor