Provider Demographics
NPI:1285383687
Name:DOHERTY, ERIK (DC)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:
Last Name:DOHERTY
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 1:35 MARY ST
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-1829
Mailing Address - Country:US
Mailing Address - Phone:732-272-5684
Mailing Address - Fax:
Practice Address - Street 1:1273 N CHURCH ST STE 100
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1115
Practice Address - Country:US
Practice Address - Phone:856-222-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00789400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor