Provider Demographics
NPI:1083854566
Name:PREMIER HEALTH OF SUMMIT LLC
Entity Type:Organization
Organization Name:PREMIER HEALTH OF SUMMIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-839-1003
Mailing Address - Street 1:47 MAPLE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2571
Mailing Address - Country:US
Mailing Address - Phone:973-839-1003
Mailing Address - Fax:973-839-3653
Practice Address - Street 1:47 MAPLE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2571
Practice Address - Country:US
Practice Address - Phone:973-839-1003
Practice Address - Fax:973-839-3653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00656700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty