Provider Demographics
NPI:1194118752
Name:ADVANCE CHIROPRACTIC CLINICS P C
Entity type:Organization
Organization Name:ADVANCE CHIROPRACTIC CLINICS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAREMBOYM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-340-1006
Mailing Address - Street 1:57 BRANT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1568
Mailing Address - Country:US
Mailing Address - Phone:732-340-1006
Mailing Address - Fax:732-340-1433
Practice Address - Street 1:57 BRANT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1568
Practice Address - Country:US
Practice Address - Phone:732-340-1006
Practice Address - Fax:732-340-1433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38 MC00568300261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service