1396009387 NPI number — FAMILY CHIROPRACTIC CENTER

Table of content: (NPI 1396009387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396009387 NPI number — FAMILY CHIROPRACTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY CHIROPRACTIC CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396009387
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
81 HWY 31
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLEMINGTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08822-1252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-788-5050
Provider Business Mailing Address Fax Number:
908-788-5652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 HWY 31
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLEMINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08822-1252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-788-5050
Provider Business Practice Location Address Fax Number:
908-788-5652
Provider Enumeration Date:
06/25/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DOWLING
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
908-788-5050

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 350046658 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0489603 . This is a "AETNA/US HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".