Provider Demographics
NPI:1548352453
Name:BADER, GREGORY MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MICHAEL
Last Name:BADER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 ROUTE 206
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-2124
Mailing Address - Country:US
Mailing Address - Phone:609-424-3186
Mailing Address - Fax:609-424-3188
Practice Address - Street 1:1028 ROUTE 206
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-2124
Practice Address - Country:US
Practice Address - Phone:609-424-3186
Practice Address - Fax:609-424-3188
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00647100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor