Provider Demographics
NPI:1194985598
Name:LEXINGTON AVENUE CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:LEXINGTON AVENUE CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:BS,BT,MES,DC
Authorized Official - Phone:609-882-7719
Mailing Address - Street 1:19 LEXINGTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-2300
Mailing Address - Country:US
Mailing Address - Phone:609-882-7719
Mailing Address - Fax:609-882-7720
Practice Address - Street 1:19 LEXINGTON AVE STE A
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-2300
Practice Address - Country:US
Practice Address - Phone:609-882-7719
Practice Address - Fax:609-882-7720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC00560100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty