Provider Demographics
NPI:1275824278
Name:NORTH JERSEY CHIROPRACTIC REHABILITATION CENTER, LLC
Entity type:Organization
Organization Name:NORTH JERSEY CHIROPRACTIC REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DE FELICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-835-6669
Mailing Address - Street 1:14 WANAQUE AVE
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-2062
Mailing Address - Country:US
Mailing Address - Phone:973-835-6669
Mailing Address - Fax:973-835-4355
Practice Address - Street 1:14 WANAQUE AVE
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-2062
Practice Address - Country:US
Practice Address - Phone:973-835-6669
Practice Address - Fax:973-835-4355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00508000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty