Provider Demographics
NPI:1043418288
Name:PELTZMAN CHIROPRACTIC ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PELTZMAN CHIROPRACTIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:G
Authorized Official - Last Name:PELTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-566-7658
Mailing Address - Street 1:591 HWY 34
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3049
Mailing Address - Country:US
Mailing Address - Phone:732-566-7658
Mailing Address - Fax:732-583-7847
Practice Address - Street 1:591 HWY 34
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3049
Practice Address - Country:US
Practice Address - Phone:732-566-7658
Practice Address - Fax:732-583-7847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00357200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ715758Medicare PIN