Provider Demographics
NPI:1609087113
Name:HALEDON ADVANCED CHIROPRACTIC LLC
Entity type:Organization
Organization Name:HALEDON ADVANCED CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:KHALAF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-447-0346
Mailing Address - Street 1:401 HALEDON AVE
Mailing Address - Street 2:FIRST FLOOR SUITE D
Mailing Address - City:HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-1553
Mailing Address - Country:US
Mailing Address - Phone:201-447-0346
Mailing Address - Fax:201-447-1582
Practice Address - Street 1:401 HALEDON AVE
Practice Address - Street 2:FIRST FLOOR SUITE D
Practice Address - City:HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-1553
Practice Address - Country:US
Practice Address - Phone:201-447-0346
Practice Address - Fax:201-447-1582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00630100111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty