Provider Demographics
NPI:1093877904
Name:SICKLERVILLE CHIROPRACTIC
Entity Type:Organization
Organization Name:SICKLERVILLE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGGIANI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-875-1515
Mailing Address - Street 1:504 SICKLERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-2626
Mailing Address - Country:US
Mailing Address - Phone:856-875-1515
Mailing Address - Fax:
Practice Address - Street 1:504 SICKLERVILLE RD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-2626
Practice Address - Country:US
Practice Address - Phone:856-875-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03689261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ642244PPMMedicare PIN
NJU09649Medicare UPIN