Provider Demographics
NPI:1407184906
Name:MADISON AVENUE CHIROPRACTIC GROUP, P.C.
Entity type:Organization
Organization Name:MADISON AVENUE CHIROPRACTIC GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:STINNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-683-0300
Mailing Address - Street 1:95 MADISON AVE
Mailing Address - Street 2:SUITE 407
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6092
Mailing Address - Country:US
Mailing Address - Phone:973-683-0300
Mailing Address - Fax:973-683-0301
Practice Address - Street 1:95 MADISON AVE
Practice Address - Street 2:SUITE 407
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6092
Practice Address - Country:US
Practice Address - Phone:973-683-0300
Practice Address - Fax:973-683-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00474000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ837234Medicare PIN