Provider Demographics
NPI:1043373640
Name:DIBARTOLO CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:DIBARTOLO CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DIBARTOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-926-1100
Mailing Address - Street 1:4036 OCEAN HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-7505
Mailing Address - Country:US
Mailing Address - Phone:609-926-1100
Mailing Address - Fax:609-926-0054
Practice Address - Street 1:4036 OCEAN HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-7505
Practice Address - Country:US
Practice Address - Phone:609-926-1100
Practice Address - Fax:609-926-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00311300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ556941Medicare PIN