Provider Demographics
NPI:1699135178
Name:BRICK CITY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BRICK CITY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOWE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-268-2226
Mailing Address - Street 1:509 ORANGE ST
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-2128
Mailing Address - Country:US
Mailing Address - Phone:973-268-2226
Mailing Address - Fax:973-497-1021
Practice Address - Street 1:509 ORANGE ST
Practice Address - Street 2:FLOOR 2
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-2128
Practice Address - Country:US
Practice Address - Phone:973-268-2226
Practice Address - Fax:973-497-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38 MC00345000261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center