Provider Demographics
NPI:1093880163
Name:COMPLETE CHIROPRACTIC AND REHAB OF MENDHAM, LLC
Entity Type:Organization
Organization Name:COMPLETE CHIROPRACTIC AND REHAB OF MENDHAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SPRIET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-543-1110
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-0177
Mailing Address - Country:US
Mailing Address - Phone:973-543-1110
Mailing Address - Fax:
Practice Address - Street 1:129 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-8616
Practice Address - Country:US
Practice Address - Phone:973-543-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00394600111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU43655Medicare UPIN
NJ093547Medicare PIN