Provider Demographics
NPI:1104956416
Name:BERGEN COUNTY CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:BERGEN COUNTY CHIROPRACTIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:SALVATORE
Authorized Official - Last Name:ESPOSITO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-384-3300
Mailing Address - Street 1:175 WASHINGTON AVE
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628
Mailing Address - Country:US
Mailing Address - Phone:201-384-3300
Mailing Address - Fax:201-384-2745
Practice Address - Street 1:175 WASHINGTON AVE
Practice Address - Street 2:SUITE ONE
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628
Practice Address - Country:US
Practice Address - Phone:201-384-3300
Practice Address - Fax:201-384-2745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00416900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ42729Medicare UPIN
NJ424672Medicare PIN