Provider Demographics
NPI:1447527759
Name:GENOVA CHIROPRACTIC CENTER,PC
Entity type:Organization
Organization Name:GENOVA CHIROPRACTIC CENTER,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GENOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-582-2112
Mailing Address - Street 1:484 DELSEA DR
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9327
Mailing Address - Country:US
Mailing Address - Phone:856-582-2112
Mailing Address - Fax:856-582-2290
Practice Address - Street 1:484 DELSEA DR
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9327
Practice Address - Country:US
Practice Address - Phone:856-582-2112
Practice Address - Fax:856-582-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00364200111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty