Provider Demographics
NPI:1447681374
Name:PURE HEALTH CHIROPRACTIC LLC
Entity type:Organization
Organization Name:PURE HEALTH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPITONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-747-0083
Mailing Address - Street 1:210 W FRONT ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1155
Mailing Address - Country:US
Mailing Address - Phone:732-747-0083
Mailing Address - Fax:732-747-6652
Practice Address - Street 1:210 W FRONT ST
Practice Address - Street 2:SUITE 209
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1155
Practice Address - Country:US
Practice Address - Phone:732-747-0083
Practice Address - Fax:732-747-6652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00703400261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1093056657Medicaid