Provider Demographics
NPI:1386704559
Name:SCORDILIS FAMILY CHIROPRACTIC, PA
Entity type:Organization
Organization Name:SCORDILIS FAMILY CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCORDILIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-473-4481
Mailing Address - Street 1:300 BROADACRES DR STE 126
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3153
Mailing Address - Country:US
Mailing Address - Phone:973-473-4481
Mailing Address - Fax:973-473-8852
Practice Address - Street 1:300 BROADACRES DR STE 126
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3153
Practice Address - Country:US
Practice Address - Phone:973-473-4481
Practice Address - Fax:973-473-8852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00175000111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ097921Medicare UPIN