Provider Demographics
NPI:1962563767
Name:PLAZA CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:PLAZA CHIROPRACTIC, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:ENGLISH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-689-2212
Mailing Address - Street 1:1 BETHANY RD
Mailing Address - Street 2:SUITE 25
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1663
Mailing Address - Country:US
Mailing Address - Phone:732-264-9005
Mailing Address - Fax:732-264-9478
Practice Address - Street 1:1 BETHANY RD
Practice Address - Street 2:SUITE 25
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1663
Practice Address - Country:US
Practice Address - Phone:732-264-9005
Practice Address - Fax:732-264-9478
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLAZA CHIROPRACTIC, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-13
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC005062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJX33330Medicare UPIN
NJ901578Medicare PIN