Provider Demographics
NPI:1588120851
Name:DINKIN, JEREMY SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:SCOTT
Last Name:DINKIN
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 1:700 BANGS AVE UNIT 214
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-6958
Mailing Address - Country:US
Mailing Address - Phone:732-996-6185
Mailing Address - Fax:
Practice Address - Street 1:908 OAK TREE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5100
Practice Address - Country:US
Practice Address - Phone:732-603-0783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00759100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD45043958208904OtherCHIROPRACTIC
NJ38MC00759100OtherCHIROPRACTIC