Provider Demographics
NPI:1447959622
Name:RECHARGE CHIROPRACTIC AND SPORTS REHAB LLC
Entity type:Organization
Organization Name:RECHARGE CHIROPRACTIC AND SPORTS REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DISPENZIERE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-956-3984
Mailing Address - Street 1:55 US HIGHWAY 202
Mailing Address - Street 2:
Mailing Address - City:FAR HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07931-2445
Mailing Address - Country:US
Mailing Address - Phone:908-956-3984
Mailing Address - Fax:
Practice Address - Street 1:55 US HIGHWAY 202
Practice Address - Street 2:
Practice Address - City:FAR HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07931-2445
Practice Address - Country:US
Practice Address - Phone:908-956-3984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1275157729OtherINDIVIDUAL NPI
NJ1689264632OtherINDIVIDUAL NPI