Provider Demographics
NPI:1043251416
Name:CHIRO REHAB INSTITUTE, LLC
Entity Type:Organization
Organization Name:CHIRO REHAB INSTITUTE, LLC
Other - Org Name:REHABILITATION INSTITUTE OF NORTH JERSEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER - CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:POGORELEC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-405-6464
Mailing Address - Street 1:1 S MAIN ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-2240
Mailing Address - Country:US
Mailing Address - Phone:973-405-6464
Mailing Address - Fax:973-405-6846
Practice Address - Street 1:1 S MAIN ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-2240
Practice Address - Country:US
Practice Address - Phone:973-405-6464
Practice Address - Fax:973-405-6846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00559000111N00000X
NJ38MC00570300111N00000X
NJ40QA01022800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ101290Medicare PIN