Provider Demographics
NPI:1124352265
Name:DOUR, JENNIFER (DC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DOUR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BRIGHTON RD STE 304
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1665
Mailing Address - Country:US
Mailing Address - Phone:732-570-8491
Mailing Address - Fax:973-860-2434
Practice Address - Street 1:4 BRIGHTON RD STE 304
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1665
Practice Address - Country:US
Practice Address - Phone:732-570-8491
Practice Address - Fax:973-860-2434
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00655600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861907180OtherCHIROPRACTOR