Provider Demographics
NPI:1366571010
Name:DR. JAIMEE C. KUKLA, CHIROPRACTOR, P.C.
Entity type:Organization
Organization Name:DR. JAIMEE C. KUKLA, CHIROPRACTOR, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAIMEE
Authorized Official - Middle Name:C
Authorized Official - Last Name:KUKLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-844-9800
Mailing Address - Street 1:2 PRINCESS RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2302
Mailing Address - Country:US
Mailing Address - Phone:609-844-9800
Mailing Address - Fax:609-844-9848
Practice Address - Street 1:2 PRINCESS RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2302
Practice Address - Country:US
Practice Address - Phone:609-844-9800
Practice Address - Fax:609-844-9848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ042488Medicare ID - Type Unspecified