Provider Demographics
NPI:1528234770
Name:CHIROPRACTIC HEALTH CLINIC
Entity type:Organization
Organization Name:CHIROPRACTIC HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-454-2666
Mailing Address - Street 1:725 ROUTE 57
Mailing Address - Street 2:PO BOX 26
Mailing Address - City:STEWARTSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08886-0026
Mailing Address - Country:US
Mailing Address - Phone:908-454-2666
Mailing Address - Fax:908-454-3315
Practice Address - Street 1:725 ROUTE 57
Practice Address - Street 2:
Practice Address - City:STEWARTSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08886-0026
Practice Address - Country:US
Practice Address - Phone:908-454-2666
Practice Address - Fax:908-454-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ009383Medicare PIN
NJU70314Medicare UPIN