Provider Demographics
NPI:1962512541
Name:BACK CARE PROFESSIONALS, LLC
Entity type:Organization
Organization Name:BACK CARE PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-586-5009
Mailing Address - Street 1:2452 KUSER RD STE D
Mailing Address - Street 2:
Mailing Address - City:HAMILTON SQUARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3360
Mailing Address - Country:US
Mailing Address - Phone:609-586-5009
Mailing Address - Fax:609-586-9905
Practice Address - Street 1:2452 KUSER RD STE D
Practice Address - Street 2:
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08690-3360
Practice Address - Country:US
Practice Address - Phone:609-586-5009
Practice Address - Fax:609-586-9905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00326600111N00000X
NJ38MC00296700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT48593Medicare UPIN
NJ574767P06Medicare ID - Type UnspecifiedNEAL F. MATHEWS, D.C.
NJ644235P06Medicare ID - Type UnspecifiedJEFFREY C. COOK, D.C.
NJU01567Medicare UPIN