Provider Demographics
NPI:1063723062
Name:NORTHFIELD SPINE AND INJURY CENTER PC
Entity type:Organization
Organization Name:NORTHFIELD SPINE AND INJURY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:NEUNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-645-8954
Mailing Address - Street 1:523 TILTON RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1217
Mailing Address - Country:US
Mailing Address - Phone:609-645-8954
Mailing Address - Fax:609-645-2935
Practice Address - Street 1:523 TILTON RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1217
Practice Address - Country:US
Practice Address - Phone:609-645-8954
Practice Address - Fax:609-645-2935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00368000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT84900Medicare UPIN