Provider Demographics
NPI:1720117252
Name:CRESTWOOD MANCHESTER CHIROPRACTIC
Entity type:Organization
Organization Name:CRESTWOOD MANCHESTER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:DLOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-657-2225
Mailing Address - Street 1:1229 JASAM CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1356
Mailing Address - Country:US
Mailing Address - Phone:732-240-4810
Mailing Address - Fax:
Practice Address - Street 1:2116 HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NJ
Practice Address - Zip Code:08759
Practice Address - Country:US
Practice Address - Phone:732-657-2225
Practice Address - Fax:732-657-2598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY941106OtherLANDMARK
NY941106OtherLANDMARK