Provider Demographics
NPI:1215334289
Name:KINGSBURY, FRED (DC)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:KINGSBURY
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 1:18 E UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1700
Mailing Address - Country:US
Mailing Address - Phone:732-563-6737
Mailing Address - Fax:732-560-1526
Practice Address - Street 1:18 E UNION AVE
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1700
Practice Address - Country:US
Practice Address - Phone:732-563-6737
Practice Address - Fax:732-560-1526
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00164900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor