Provider Demographics
NPI:1104919802
Name:SEUGLING, RAYMOND A JR (DC)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:A
Last Name:SEUGLING
Suffix:JR
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 1:777 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3479
Mailing Address - Country:US
Mailing Address - Phone:973-696-0500
Mailing Address - Fax:973-696-5959
Practice Address - Street 1:777 VALLEY RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3479
Practice Address - Country:US
Practice Address - Phone:973-696-0500
Practice Address - Fax:973-696-5959
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00120700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2799308Medicaid
NJ222071263OtherTAX ID NUMBER
NJ2799308Medicaid
NJT45217Medicare UPIN