Provider Demographics
NPI:1063602357
Name:OHEA CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:OHEA CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:OHEA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-714-1899
Mailing Address - Street 1:30 JACKSON ROAD
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055
Mailing Address - Country:US
Mailing Address - Phone:609-714-1899
Mailing Address - Fax:609-714-8218
Practice Address - Street 1:30 JACKSON ROAD
Practice Address - Street 2:SUITE A-2
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055
Practice Address - Country:US
Practice Address - Phone:609-714-1899
Practice Address - Fax:609-714-8218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU36848Medicare UPIN
NJ421398Medicare PIN