Provider Demographics
NPI:1003107913
Name:MONMOUTH SPINE CENTER LLC
Entity Type:Organization
Organization Name:MONMOUTH SPINE CENTER LLC
Other - Org Name:RIVERSIDE WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHEERIN
Authorized Official - Suffix:
Authorized Official - Credentials:BS,DC
Authorized Official - Phone:732-747-2000
Mailing Address - Street 1:55 N GILBERT ST STE 3101
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4959
Mailing Address - Country:US
Mailing Address - Phone:732-747-2000
Mailing Address - Fax:732-933-1744
Practice Address - Street 1:55 N GILBERT ST STE 3101
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:732-747-2000
Practice Address - Fax:732-933-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00629100111N00000X
NJ40QA00129300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty