Provider Demographics
NPI:1942384540
Name:BOTT, CHRISTOPHER J (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:BOTT
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 1:382 W 9TH ST
Mailing Address - Street 2:STE 3
Mailing Address - City:SHIP BOTTOM
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-4634
Mailing Address - Country:US
Mailing Address - Phone:609-361-1800
Mailing Address - Fax:609-361-8400
Practice Address - Street 1:382 W 9TH ST
Practice Address - Street 2:STE 3
Practice Address - City:SHIP BOTTOM
Practice Address - State:NJ
Practice Address - Zip Code:08008-4634
Practice Address - Country:US
Practice Address - Phone:609-361-1800
Practice Address - Fax:609-361-8400
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00506300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU71649Medicare UPIN
NJ014327Medicare ID - Type Unspecified