Provider Demographics
NPI:1053466557
Name:FAMILY CHIROPRACTIC CENTER OF DENVILLE
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC CENTER OF DENVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TAGGART
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:973-586-1011
Mailing Address - Street 1:94 DIAMOND SPRING RD
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2775
Mailing Address - Country:US
Mailing Address - Phone:973-586-1011
Mailing Address - Fax:973-586-6439
Practice Address - Street 1:171 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3319
Practice Address - Country:US
Practice Address - Phone:973-586-1011
Practice Address - Fax:973-586-6439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC 04875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ107413Medicare PIN