Provider Demographics
NPI:1033647730
Name:BAREFOOT REHABILITATION CLINIC NJ
Entity Type:Organization
Organization Name:BAREFOOT REHABILITATION CLINIC NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DE PINTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-205-4847
Mailing Address - Street 1:26 BLOOMFIELD AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2771
Mailing Address - Country:US
Mailing Address - Phone:862-205-4847
Mailing Address - Fax:732-011-1192
Practice Address - Street 1:26 BLOOMFIELD AVE STE 4
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2771
Practice Address - Country:US
Practice Address - Phone:862-205-4847
Practice Address - Fax:732-011-1192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-25
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty