Provider Demographics
NPI:1447374483
Name:SAMUELS, HORACE (DC)
Entity type:Individual
Prefix:DR
First Name:HORACE
Middle Name:
Last Name:SAMUELS
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 1:713 GREENWOOD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08609-1401
Mailing Address - Country:US
Mailing Address - Phone:609-394-1100
Mailing Address - Fax:609-394-7100
Practice Address - Street 1:713 GREENWOOD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08609-1401
Practice Address - Country:US
Practice Address - Phone:609-394-1100
Practice Address - Fax:609-394-7100
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00597900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0027421Medicaid
NJ058638Medicare ID - Type UnspecifiedMEDICARE#
NJ0027421Medicaid