Provider Demographics
NPI:1215968623
Name:FRESH, JENNIFER M (DC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:FRESH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:WALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:6 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-2500
Mailing Address - Country:US
Mailing Address - Phone:609-926-8900
Mailing Address - Fax:609-926-8989
Practice Address - Street 1:6 SHORE RD
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2500
Practice Address - Country:US
Practice Address - Phone:609-926-8900
Practice Address - Fax:609-926-8989
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01040111N00000X
NJ38MC00599500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor