Provider Demographics
NPI:1073654257
Name:MIDDLESEX CHIROPRACTIC ASSOCIATES
Entity Type:Organization
Organization Name:MIDDLESEX CHIROPRACTIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GURRERE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-748-9944
Mailing Address - Street 1:1317 BOUND BROOK RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-1945
Mailing Address - Country:US
Mailing Address - Phone:732-748-9944
Mailing Address - Fax:732-748-0800
Practice Address - Street 1:1317 BOUND BROOK RD
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-1945
Practice Address - Country:US
Practice Address - Phone:732-748-9944
Practice Address - Fax:732-748-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00561500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ078567Medicare ID - Type Unspecified