Provider Demographics
NPI: | 1134858004 |
---|---|
Name: | CHIROPRACTIC AND REHAB EXERCISE CENTER CARECENTER OF S JERSEY NORTH |
Entity type: | Organization |
Organization Name: | CHIROPRACTIC AND REHAB EXERCISE CENTER CARECENTER OF S JERSEY NORTH |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CREDENTIAL |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CAROL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | JOHNSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 856-616-0610 |
Mailing Address - Street 1: | 1937 HADDONFIELD BERLIN RD |
Mailing Address - Street 2: | |
Mailing Address - City: | CHERRY HILL |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08003-3737 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 856-616-0610 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 623 TILTON RD |
Practice Address - Street 2: | |
Practice Address - City: | NORTHFIELD |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08225-1219 |
Practice Address - Country: | US |
Practice Address - Phone: | 609-645-8954 |
Practice Address - Fax: | 609-645-2935 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-06-07 |
Last Update Date: | 2022-06-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |