Provider Demographics
NPI:1033503214
Name:PLAZA CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:PLAZA CHIROPRACTIC CENTER
Other - Org Name:DR. IRA SHAPIRO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-723-0023
Mailing Address - Street 1:1314 ENGLISHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1580
Mailing Address - Country:US
Mailing Address - Phone:732-723-0023
Mailing Address - Fax:732-723-1614
Practice Address - Street 1:1314 ENGLISHTOWN RD
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1580
Practice Address - Country:US
Practice Address - Phone:732-723-0023
Practice Address - Fax:732-723-1614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00270800111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ111NS00005XOtherTAXONOMY
NJ1497731319OtherNPI
NJ5565901Medicaid
NJ1497731319OtherNPI