Provider Demographics
NPI:1033282744
Name:WEST CALDWELL CHIROPRACTIC CENTER, P.A.
Entity Type:Organization
Organization Name:WEST CALDWELL CHIROPRACTIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GIASULLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-575-8363
Mailing Address - Street 1:1140 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7130
Mailing Address - Country:US
Mailing Address - Phone:973-575-8363
Mailing Address - Fax:973-575-4027
Practice Address - Street 1:1140 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7130
Practice Address - Country:US
Practice Address - Phone:973-575-8363
Practice Address - Fax:973-575-4027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00148500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ461719Medicare ID - Type Unspecified