Provider Demographics
NPI:1053436519
Name:CONTRERAS, MARIBEL (DC)
Entity type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:CONTRERAS
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 1:6307 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-3420
Mailing Address - Country:US
Mailing Address - Phone:201-453-2211
Mailing Address - Fax:201-453-2212
Practice Address - Street 1:6307 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-3420
Practice Address - Country:US
Practice Address - Phone:201-453-2211
Practice Address - Fax:201-453-2212
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00564800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8413401Medicaid
NJ8413401Medicaid