Provider Demographics
NPI:1306317292
Name:INTRINSIC CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:INTRINSIC CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JODI
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-833-9000
Mailing Address - Street 1:1600 HIGHWAY 71 # A
Mailing Address - Street 2:
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-4803
Mailing Address - Country:US
Mailing Address - Phone:732-894-3333
Mailing Address - Fax:732-894-3330
Practice Address - Street 1:1600 HIGHWAY 71 # A
Practice Address - Street 2:
Practice Address - City:BELMAR
Practice Address - State:NJ
Practice Address - Zip Code:07719-4803
Practice Address - Country:US
Practice Address - Phone:732-894-3333
Practice Address - Fax:732-894-3330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINNEY CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1194939827OtherINDIVIDUAL NPI
NJ1093076796OtherGROUP NPI