Provider Demographics
NPI:1871782821
Name:SHORE CHRIPRACTIC CENTER
Entity type:Organization
Organization Name:SHORE CHRIPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:HADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:609-646-0578
Mailing Address - Street 1:2400 SHEPHERD CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1419
Mailing Address - Country:US
Mailing Address - Phone:609-646-0578
Mailing Address - Fax:609-646-9289
Practice Address - Street 1:2400 SHEPHERD CIR
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1419
Practice Address - Country:US
Practice Address - Phone:609-646-0578
Practice Address - Fax:609-646-9289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00243800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ194544OtherBCBS PIN
NJ0091581000OtherAMERIHEALTH PIN
NJ194544OtherBCBS PIN
NJ194544Medicare PIN