Provider Demographics
NPI:1154738466
Name:PURE HEALING CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:PURE HEALING CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-981-7560
Mailing Address - Street 1:1351 KUSER RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3824
Mailing Address - Country:US
Mailing Address - Phone:609-981-7560
Mailing Address - Fax:
Practice Address - Street 1:1351 KUSER RD
Practice Address - Street 2:SUITE 4
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3824
Practice Address - Country:US
Practice Address - Phone:609-981-7560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00717800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty