Provider Demographics
NPI:1063923647
Name:ELITE PERFORMANCE CHIROPRACTIC AND PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:ELITE PERFORMANCE CHIROPRACTIC AND PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LACOGNATA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-970-6848
Mailing Address - Street 1:252 NOTTINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-9517
Mailing Address - Country:US
Mailing Address - Phone:732-441-9898
Mailing Address - Fax:732-441-9555
Practice Address - Street 1:1061 ROUTE 34 STE B
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2171
Practice Address - Country:US
Practice Address - Phone:973-970-6848
Practice Address - Fax:973-970-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01427400225100000X
NJ40QA01576500225100000X
NJ40QA00491800225100000X
NJ38MC00470000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty