Provider Demographics
NPI:1073792057
Name:MORRIS COUNTY COMMUNITY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:MORRIS COUNTY COMMUNITY CHIROPRACTIC CENTER
Other - Org Name:COMMUNITY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WULSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-625-7800
Mailing Address - Street 1:35 W MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2174
Mailing Address - Country:US
Mailing Address - Phone:973-625-7800
Mailing Address - Fax:973-627-6982
Practice Address - Street 1:35 W MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2174
Practice Address - Country:US
Practice Address - Phone:973-625-7800
Practice Address - Fax:973-627-6982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00260800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ021371MXHOtherINDIVIDUAL IN GROUP ID
NJ021371MXHOtherINDIVIDUAL IN GROUP ID
NJU98670Medicare PIN