Provider Demographics
NPI:1194152116
Name:SOMERS POINT CHIROPRACTIC CTR.
Entity type:Organization
Organization Name:SOMERS POINT CHIROPRACTIC CTR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:P
Authorized Official - Last Name:GRAZIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-653-8300
Mailing Address - Street 1:320 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2634
Mailing Address - Country:US
Mailing Address - Phone:609-653-8300
Mailing Address - Fax:
Practice Address - Street 1:320 SHORE RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2634
Practice Address - Country:US
Practice Address - Phone:609-653-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00168200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty