Provider Demographics
NPI:1003905050
Name:SOUTH AMBOY CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:SOUTH AMBOY CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:MARULLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-727-5502
Mailing Address - Street 1:137 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-3412
Mailing Address - Country:US
Mailing Address - Phone:732-727-5502
Mailing Address - Fax:
Practice Address - Street 1:137 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-3412
Practice Address - Country:US
Practice Address - Phone:732-727-5502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC005814111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty