Provider Demographics
NPI:1104896299
Name:CONTINO, JEFFREY T (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:T
Last Name:CONTINO
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 1:174 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-1806
Mailing Address - Country:US
Mailing Address - Phone:856-455-2225
Mailing Address - Fax:856-455-5304
Practice Address - Street 1:174 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1806
Practice Address - Country:US
Practice Address - Phone:856-455-2225
Practice Address - Fax:856-455-5304
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMCO3440NJ111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1953508Medicaid
NJ1953508Medicaid