Provider Demographics
NPI:1992480693
Name:NJ CHIROPRACTIC ASSOCIATES LLC
Entity type:Organization
Organization Name:NJ CHIROPRACTIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:LICHY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:917-535-1948
Mailing Address - Street 1:49 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457-1127
Mailing Address - Country:US
Mailing Address - Phone:917-535-1948
Mailing Address - Fax:
Practice Address - Street 1:49 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1127
Practice Address - Country:US
Practice Address - Phone:917-535-1948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty