Provider Demographics
NPI:1194984898
Name:BLAIRSTOWN CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:BLAIRSTOWN CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIACOBBE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:908-362-8767
Mailing Address - Street 1:143 STATE ROUTE 94
Mailing Address - Street 2:
Mailing Address - City:BLAIRSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07825-2214
Mailing Address - Country:US
Mailing Address - Phone:908-362-8767
Mailing Address - Fax:908-362-8770
Practice Address - Street 1:143 STATE ROUTE 94
Practice Address - Street 2:
Practice Address - City:BLAIRSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07825-2214
Practice Address - Country:US
Practice Address - Phone:908-362-8767
Practice Address - Fax:908-362-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00455900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ695627Medicare PIN