Provider Demographics
NPI:1285709204
Name:LAFFERTY, ANTHONY ANGELO (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ANGELO
Last Name:LAFFERTY
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 1:403 COMMERCE LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08091-2513
Mailing Address - Country:US
Mailing Address - Phone:856-768-7737
Mailing Address - Fax:856-768-4477
Practice Address - Street 1:403 COMMERCE LN
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-2513
Practice Address - Country:US
Practice Address - Phone:856-768-7737
Practice Address - Fax:856-768-4477
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006602L111N00000X
NJ38MC00484700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
854897Medicare ID - Type Unspecified