Provider Demographics
NPI:1982776233
Name:WULSTER, JERSEY A (DC)
Entity type:Individual
Prefix:
First Name:JERSEY
Middle Name:A
Last Name:WULSTER
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 1:25 ORCHARD ST STE 103
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2160
Mailing Address - Country:US
Mailing Address - Phone:973-625-7800
Mailing Address - Fax:973-627-6982
Practice Address - Street 1:25 ORCHARD ST STE 103
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2160
Practice Address - Country:US
Practice Address - Phone:973-625-7800
Practice Address - Fax:973-627-6982
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00260800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ933584OtherAETNA HOM
NJ4270559OtherAETNA NON HMO
NJ021371MXHMedicare PIN