Provider Demographics
NPI:1093201220
Name:NEW VERNON CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:NEW VERNON CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:KLOK
Authorized Official - Last Name:BEVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-984-5200
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:NEW VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07976-0009
Mailing Address - Country:US
Mailing Address - Phone:973-984-5200
Mailing Address - Fax:973-984-3020
Practice Address - Street 1:4 VILLAGE ROAD
Practice Address - Street 2:
Practice Address - City:NEW VERNON
Practice Address - State:NJ
Practice Address - Zip Code:07976-0009
Practice Address - Country:US
Practice Address - Phone:973-984-5200
Practice Address - Fax:973-984-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC00223500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty