Provider Demographics
NPI:1003296963
Name:EICKHOFF CHIROPRACTIC AND NUTRITION
Entity Type:Organization
Organization Name:EICKHOFF CHIROPRACTIC AND NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:AVERSA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-404-8190
Mailing Address - Street 1:111 PASSAIC AVE
Mailing Address - Street 2:APT A7
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3818
Mailing Address - Country:US
Mailing Address - Phone:315-404-8190
Mailing Address - Fax:
Practice Address - Street 1:1011 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3518
Practice Address - Country:US
Practice Address - Phone:973-470-0687
Practice Address - Fax:973-470-0862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00724400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty