Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 38MC00734400 | NJ |
NPI | 1164883641 |
---|---|
Provider Name | Racquel Decaro |
First Address | Matawan, NJ 07747-2132 |
Second Address | Matawan, NJ 07747-2132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2016 |
Last Update Date | 11/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38MC00734400 | CHIROPRACTIC LIECENSE (01) | NJ |