Provider Demographics
NPI:1699908616
Name:DE ANDRADE FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:DE ANDRADE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GISELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-839-1003
Mailing Address - Street 1:1015 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2844
Mailing Address - Country:US
Mailing Address - Phone:973-839-1003
Mailing Address - Fax:973-839-3653
Practice Address - Street 1:1015 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2844
Practice Address - Country:US
Practice Address - Phone:973-839-1003
Practice Address - Fax:973-839-3653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00644900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty