Provider Demographics
NPI:1063682474
Name:SUN UP CHIROPRACTIC AND PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:SUN UP CHIROPRACTIC AND PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:OMERKIAM
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:BAKSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-433-7760
Mailing Address - Street 1:679 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3324
Mailing Address - Country:US
Mailing Address - Phone:201-433-7760
Mailing Address - Fax:
Practice Address - Street 1:679 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3324
Practice Address - Country:US
Practice Address - Phone:201-433-7760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00625000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty