Provider Demographics
NPI:1023551769
Name:KANE FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:KANE FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-544-3585
Mailing Address - Street 1:1361 FAIRVIEW BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-1473
Mailing Address - Country:US
Mailing Address - Phone:856-544-3585
Mailing Address - Fax:856-544-3586
Practice Address - Street 1:1361 FAIRVIEW BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-1473
Practice Address - Country:US
Practice Address - Phone:856-544-3585
Practice Address - Fax:856-544-3586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00725100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty