Provider Demographics
NPI:1306935796
Name:FRESH, JOHN P (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:FRESH
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 1:6 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:2006-10-12
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01001111N00000X
NJ38MC00599600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV00360Medicare UPIN
NV39580Medicare ID - Type Unspecified