Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 38MC00282200 | NJ |
NPI | 1184713398 |
---|---|
Provider Name | Dr. Louis L. Demoulin |
First Address | Marmora, NJ 08223-1206 |
Second Address | Marmora, NJ 08223-1206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 06/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
520540RSV | MEDICARE PTAN (01) |