Provider Demographics
NPI:1114309887
Name:EAST BLACKWELL CHIROPRACTIC
Entity Type:Organization
Organization Name:EAST BLACKWELL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MYAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOHNARTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-361-3500
Mailing Address - Street 1:2 E BLACKWELL ST
Mailing Address - Street 2:SUITE 15
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-4645
Mailing Address - Country:US
Mailing Address - Phone:973-361-3500
Mailing Address - Fax:973-361-1360
Practice Address - Street 1:23 ROUTE 15
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:NJ
Practice Address - Zip Code:07848-2022
Practice Address - Country:US
Practice Address - Phone:973-361-3500
Practice Address - Fax:973-361-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00459200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty