Provider Demographics
NPI:1093989386
Name:CHIROPRACTIC FAMILY & SPORTS INJURY CENTER
Entity Type:Organization
Organization Name:CHIROPRACTIC FAMILY & SPORTS INJURY CENTER
Other - Org Name:ALFONSE DE MARIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFONSE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DE MARIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-891-5599
Mailing Address - Street 1:807 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07481
Mailing Address - Country:US
Mailing Address - Phone:201-891-5599
Mailing Address - Fax:
Practice Address - Street 1:807 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07481
Practice Address - Country:US
Practice Address - Phone:201-891-5599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04071111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ402971Medicare PIN