Provider Demographics
NPI:1033303698
Name:MAHER 64 CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:MAHER 64 CHIROPRACTIC, LLC
Other - Org Name:MT OLIVE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAHER
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:973-347-0500
Mailing Address - Street 1:98 US HIGHWAY 46
Mailing Address - Street 2:VILLAGE GREEN ANNEX
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828-1818
Mailing Address - Country:US
Mailing Address - Phone:973-347-0500
Mailing Address - Fax:973-347-1512
Practice Address - Street 1:98 US HIGHWAY 46
Practice Address - Street 2:VILLAGE GREEN ANNEX
Practice Address - City:BUDD LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07828-1818
Practice Address - Country:US
Practice Address - Phone:973-347-0500
Practice Address - Fax:973-347-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00646400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty