Provider Demographics
NPI:1588740393
Name:KACHELE, COLLEEN R (DC)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:R
Last Name:KACHELE
Suffix:
Gender:F
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:PO BOX 945
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-0945
Mailing Address - Country:US
Mailing Address - Phone:201-818-3010
Mailing Address - Fax:201-818-8799
Practice Address - Street 1:115 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-1325
Practice Address - Country:US
Practice Address - Phone:201-818-3010
Practice Address - Fax:201-818-8799
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00467700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU62801Medicare UPIN
NJ885156Medicare ID - Type Unspecified