Provider Demographics
NPI:1013184308
Name:SUMMIT SPINAL CARE LLC
Entity Type:Organization
Organization Name:SUMMIT SPINAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHERLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-839-1003
Mailing Address - Street 1:212 W ROUTE 38
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3238
Mailing Address - Country:US
Mailing Address - Phone:973-839-1003
Mailing Address - Fax:973-839-3653
Practice Address - Street 1:212 W ROUTE 38
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3238
Practice Address - Country:US
Practice Address - Phone:973-839-1003
Practice Address - Fax:973-839-3653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00598300111NR0400X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ126079Medicare PIN
NJ6306580001Medicare NSC